In health care emergencies, it may be necessary to switch a patient from one medicine to another to ensure continuity of care and to keep the patient stable. Such a switch can sometimes be difficult to achieve, especially in the case of medical products requiring individualized dose selection, such as insulin preparations. In Russia, there are no clear recommendations for switching from one insulin preparation to another in such situations. For this reason, foreign experience of switching from one insulin product to another was analyzed in conditions when the supply of the patient’s main insulin product was interrupted for various reasons. Based on the results of the literature review, it was found that the practice of replacing an insulin preparation based on one active ingredient with an insulin preparation with another active ingredient or an insulin preparation with a certain ratio of active ingredients with an insulin preparation with the same active ingredients but in a different ratio is quite common abroad. The experience obtained by foreign researchers has been systematized, and based on this work, algorithms have been proposed to help make appropriate replacement or switching decisions. Some of the proposed algorithms were further formalized, and recommendations were developed by well-known foreign agencies involved in the regulation of drug circulation, as well as by the World Health Organization. The results of this analysis may help to develop domestic approaches to insulin product replacement in health care emergencies.

The complex pathogenesis of type 2 diabetes mellitus (DM) is the basis for providing the therapeutic treatment for various disorders, which ensures a better glucose-lowering potential and maintenance of glycemic control as the disease progresses. A key reason for poor glycemic control is clinical inertia, which can be overcome by using antidiabetic fixed-dose combinations (FC). Their use improves glycemic control, as the multidirectional action of the combination components on the pathogenetic mechanisms of type 2 diabetes leads to increased pharmacological effects. The PK of metformin and sitagliptin is preferable in terms of glucose-lowering efficacy, safety and clinical benefits. The mechanism of action of metformin is not associated with the stimulation of insulin secretion by β-cells, but results from the drug’s effect on insulin sensitivity at the level of the liver, muscle and adipose tissue, although the effect on hepatic glucose production is the prevailing one. The mechanism of action of sitagliptin, a highly selective inhibitor of dipeptidyl peptidase-4, is additional to the basic pharmacological effects of metformin, which are caused by several mechanisms not associated with stimulation of insulin secretion by β-cells. The simultaneous use of sitagliptin and metformin has additive effects on the increase of glucagon-like peptide-1 levels. This action is implemented through various mechanisms, while metformin increases the release, and sitagliptin inhibits the active degradation of glucagon-like peptide-1. The article emphasizes the importance of rational combinations of glucose-lowering drugs, the need for a personalized approach to the choice of medicines. The current possibilities of sugar-reducing therapy, the issues of efficacy, safety and benefits of PK of metformin and sitagliptin are discussed using modern evidence-based data.

Introduction. Type  2 diabetes is a  significant medical problem. The solution to this problem lies not only in  lowering the patient’s blood glucose level, but also in preventing the complications of diabetes, influencing insulin resistance and normalizing body weight.

Aim. To develop an effective and safe treatment regimen for elderly women with type 2 diabetes, which is aimed at compensating carbohydrate metabolism, improving lipid metabolism and anthropometric parameters.

Materials and methods. The study involved 80 women with type 2 diabetes aged 60 to 74 years, who were divided into 2 groups of 40 people. Group 1 included patients with type 2 diabetes receiving traditional therapy for type 2 diabetes. Patients of the group 2 received the method of treatment developed by us, including, in addition to the traditional regimen, the drug Subetta®, cholecalciferol drops. All women collected complaints and anamnesis, assessed anthropometric parameters, glucose, glycated hemoglobin, vitamin D, lipid profile.

Results. All patients with type 2 diabetes initially were not compensated for carbohydrate metabolism, had abdominal obesity, atherogenic dyslipidemia, and vitamin D deficiency. Anthropometric parameters significantly improved, glucose and HbA1c levels decreased to target values in patients of group 2 after 6 months against the background of the use of Subetta® and cholecalciferol. Also in this group, the indicators of lipid metabolism improved: the levels of cholesterol, LDL, triglycerides decreased, and the levels of HDL increased. Vitamin D levels reached target range. No episodes of hypoglycemia were recorded.

Conclusions. The addition of  Subetta® and cholecalciferol to the  treatment of  patients with type  2 diabetes contributed to the achievement of target indicators of carbohydrate metabolism, improved lipid profile, and weight loss. This method of treatment is well tolerated and has a low risk of hypoglycemia, which is especially important for elderly patients.

In the prescriptions of an endocrinologist to patients with diabetes mellitus, glucagon-like peptide agonists, belonging to the group that affects the incretin system of the body, have recently been increasingly appearing. In addition to the pronounced hypoglycemic effect and high safety, these drugs also have many pleiotropic properties due to the presence of glucagon-like peptide receptors in the vascular endothelium, kidneys, heart and nervous tissue. The purpose of this work is to describe the  most studied neuroprotective effects of  this class of  drugs. As materials in  the course of  the work, studies of domestic and foreign colleagues published in the period from 2008 to 2022 were used. Our work has shown that the neuroprotective effect of GLP-1 is associated with the activation of the corresponding receptor systems in the central nervous system, which leads to increased cellular survival in ischemic conditions by reducing reactive oxygen species, stimulating beta-oxidation by mitochondria, and reducing pro-inflammatory cytokines. In addition, the analysis of the literature also established the positive role of GLP-1 in neurodegenerative diseases – drugs reduce the amount of unnormal proteins (alphasynuclein, microtubular T-peptide, etc.), reduce the activity of non-enzymatic glycation of proteins in hyperglycemia, as well as reduce insulin resistance. The effects described above were analyzed during preclinical trials of GLP-1, and also demonstrated their validity in human models during some clinical trials. However, the data obtained is not yet sufficient to form clear indications for this class of drugs in neurology, so the topic requires further study and large clinical trials.

Diabetes mellitus type 2 is a global medical and social problem, which, in terms of population coverage around the world, is becoming a pandemic. The main cause of premature death in patients with type 2 diabetes is diseases of the cardiovascular system. The presence of diabetes is associated with an increase in the risk of developing coronary heart disease by two-four times, and every sixth patient has signs of myocardial infarction in the past. The risk of developing ASCVD in patients with type 2 diabetes is early onset, rapid progression, and asymptomatic course. It is known that patients with type 2 diabetes develop ASCVD 8–10 years earlier than people of the same age group who do not have diabetes. Along with chronic hyperglycemia, an independent risk factor for  cardiovascular complications in  patients with type  2 diabetes is dyslipidemia, which occurs in  30–40% of patients. Insulin resistance, the state of chronic hyperglycemia, dyslipidemia play a key role in the development of the metabolic syndrome and atherosclerosis. The TyG index and the parameter of non-HDL-C have convincingly established themselves as predictors of the development of CVD, as well as markers reflecting signs of the presence of independent factors of the metabolic syndrome that increase the risk of CVD. Conducted clinical studies have confirmed the predictive value of these parameters in relation to CVD. This review focuses on the pathogenesis, development mechanisms, and methods for correcting lipid disorders that underlie the development of CV complications in patients with type 2 diabetes.

Introduction. Diabetes mellitus (DM) is the most common and incapacitating endocrine disorder. Diabetic foot syndrome (DFS) is one of the most serious complications of DM, which is the main cause of nontraumatic lower-extremity amputations. Despite the efforts of the entire medical community, the survival rate of DFS patients with non-healing ulcers and after foot surgery does not exceed 50% over 5 years and is comparable to the survival rates of patients with colorectal cancer.

Aim. It has been demonstrated that postsurgical diabetic foot wounds tend to chronization of inflammatory process. The diabetic autonomic neuropathy can be involved in diabetic foot damages. We hypothesized that progression of cardiovascular autonomic neuropathy  (CAN) leads to aggressive microvascular complications of  diabetes and delay the  postsurgical wound healing in diabetic foot patients during 2 years of observation.

Materials and methods. We examined 94 outpatients with postsurgical diabetic foot wounds and observation period of two years. The clinical neurological examination and standard cardiovascular autonomic reflex tests with identification of severe/advanced abnormalities were performed at baseline and after 2 years. The progression of CAN was diagnosed in cases of an increase in the amount of cardiovascular autonomic reflex tests by 1 score and more. The unsatisfactory result of wound treatment was detected in patients with wound healing delay and new cases of surgery debridement, foot amputations and Charcot foot during 2 years of observation.

Results. The mean duration of diabetes was 10.7 year, HbA1c 8.3%, LDL-Chol 3.3 mmol/l, TG 1.8 mmol/l. The 51.1% patients had been amputated in the level of foot, 48.9% patients had surgery debridement. All patients had CAN, confirmed/severe forms in 57.4% cases. The progression of CAN was found in 22.3% patients, the most of them with functional stage at baseline. The aggressive course of CAN increased the risk of progression of diabetic sensomotor neuropathy (OR = 14.6; 95% CI 3.0–70.5; p = 0.0006), nephropathy (OR = 22.4; 95% CI 3.4–147.4; p = 0.0009) and unsatisfactory result of wound treatment (OR = 40; 95% CI 6.0–268.5; p = 0.0001).

Conclusions. The patients with diabetic foot surgery wounds has high risk of confirmed/severe CAN and its progression during 2 years. The aggressive course of CAN associates with unsatisfactory result of wound treatment and progression of microvascular diabetic complications.

Type 1 diabetes mellitus (DM) is a disease characterized by hyperglycemia due to an absolute insulin deficiency caused by autoimmune destruction of insulin-producing β-cells. The disease occurs at a young age, is characterized by a labile course, a tendency to ketoacidosis and leads to the development of vascular complications that contribute to disability and early death of patients. To date, insulin therapy is the only treatment for type 1 diabetes. However, this method of treatment is not perfect. Patients need to adjust their diet, conduct frequent glycemic control and multiple injections of insulin. In this regard, the search for more effective methods of treating type 1 diabetes continues. The transformation of stem cells as a potential source of αand β-cells and their transplantation to the patient seems promising. However, it is not enough to simply obtain α- and β-cells from any stem cell. An important role is played by the interaction between the cells of the pancreatic islets. Currently, attempts are being made to develop functional in vitro models of pancreatic islets in which the cellular microenvironment would be completely preserved. The possibility of culturing and monitoring cells in a permeable three-dimensional microenvironment has been demonstrated. Combining different types of cells with each other in biologically suitable protein hydrogels allows the formation of spatial tissue systems. Cell microvascularization is also important, which is critical for adequate glucose homeostasis. 3D bioprinting can help ensure proper cell distribution in the scaffold and help reduce hypoxia through vascularization. 3D bioprinting technology will solve the  problems of  creating a  natural environment for  pancreatic islets with extracellular matrix and vasculature, since this technology will help to create organs in fully controlled conditions in vitro. However, this technology is still developing and further research is required in this direction.

Introduction. Rare types of diabetes mellitus including MODY (Maturity-Onset Diabetes of the Young) are quite complicated to verification and differential diagnosis. That is often leads to diagnostic delays, medical errors in choosing treatment tactics. This kind of event could aggravate the course of the disease and must be prevented.

Aim. Evaluation the characteristics of glucose variability (GV) in different types of diabetes mellitus (DM) in young people using continuous glucose monitoring (CGM) systems is necessary to understand the diagnostic value of the method.

Materials and methods. We studied 72 patients with clinical signs of MODY who underwent a molecular genetics study to verify the type of DM. According to the results of the study, patients were divided into 3 groups: with genetically confirmed MODY2 (n = 31), MODY3 (n = 16); comparison group consists of the patients with type 2 diabetes (n = 25). All patients at the second stage underwent CGM for 14 days. At the third stage, the obtained patterns of glycemia were presented in the form of GV indices using the GLINVA program, and an in-depth analysis of glucose variability was performed.

Results. Some features in the characteristics of the glycemic profile in young people with monogenic forms of DM were noticed. It was determined that in MODY2 the level of fasting plasma glucose (FPG) (p = 0.004) and HbA1c (p = 0.010) was significantly lower than in MODY3, and low GV was determined during the day, which probably causes a lower incidence of diabetic complications than other types of  diabetes. In individuals with MODY3, higher FPG and HbA1c values were found, in  contrast to MODY2 and type 2 diabetes. MODY3 profile is characterized with significantly higher GV and longer time spent above the target ranges (compared to type 2 diabetes).

Conclusions. The approach to evaluate the glycemic profile used in the study is modern and affordable. It could become a tool for determining criteria for diagnosing the type of diabetes in patients with clinical manifestations of MODY.

Diabetes mellitus is a  chronic metabolic disease with a  rapidly increasing prevalence. Glycemic control in  diabetes mellitus remains the key to improving the effectiveness of therapy, reducing the risk of hypoglycemia, preventing microvascular complications, and reducing the long-term risk of macrovascular complications. However, regular glycemic control is only a part of this process, since an equally important step is the timely and correct interpretation of the data obtained, as well as the decision on further therapeutic tactics. Technological advances are providing tools to help diabetic patients reach their glycemic targets and facilitate ongoing monitoring of blood glucose levels. Currently, there is the possibility of remote monitoring of glycemia, transmission of data to medical professionals and caregivers: blood glucose meters with wireless glucose reporting, continuous glucose monitors, flash glucose monitors, and non-invasive glucose monitoring systems. Large scientific studies have proven the effectiveness and prospects of telemedicine technologies in the treatment of diabetes. Today, the digitalization of healthcare is actively developing from telemedicine and remote interaction with patients to new digital approaches to diagnostics and information exchange. Thus, in  the Russian Federation, within the  framework of  the digital transformation strategy of  the Healthcare industry until 2024 and for the planned period until 2030, the Personal Medical Assistants project is being implemented, aimed at creating technologies for dynamic remote monitoring of patients using platforms of centralized diagnostic services based on a unified state information system in the field of healthcare.

One of the strategies for preventing hypoglycemia, along with structured patient education and the use of modern hypoglycemic agents, is self-control of glycemia with the achievement of individual therapeutic goals. Frequently recurring hypoglycemic episodes are associated with impaired recognition of hypoglycemia and increase the risk of severe hypoglycemia up to six times. Prevention of the development of severe hypoglycemia may be of key importance for the prevention of adverse cardiovascular events and the risk of sudden death in patients with diabetes mellitus. Repeated hypoglycemic episodes can lead to impaired recognition of hypoglycemia, as a result of which a lower blood glucose level is necessary for the development of clinical symptoms of hypoglycemia. The use of individual glucose meters is currently relevant, despite the active introduction into clinical practice of continuous monitoring of glycemia and flash monitoring. ccording to the Russian “Algorithms of specialized medical care for patients with diabetes mellitus”, patients are recommended to conduct self-monitoring using individual glucose meters at least 4 times a day when using continuous monitoring of glycemia in real time and at least 2 times a day when using flash monitoring of glycemia to assess accuracy and / or calibration monitoring data and in order to resolve the issue of correction of ongoing therapy. The desire for strict and adequate self-control dictates the need to use the latest means of glycemia control – intelligent glucose meters with high accuracy, ease of  use and reliability of  blood glucose measurements. The introduction of intelligent technologies – “smart” glucose meters using a mobile application, with the functions of “no coding”, “second chance”, data transmission to the attending physician – makes it possible to carry out remote monitoring, providing more effective management of diabetes mellitus.

Diabetes mellitus type 2 (DM2) and gout develop as a result of metabolic disorders; an obligatory component of both diseases is an increase in the level of a certain biochemical indicator – glucose in DM2 and uric acid in gout. Both nosologies are characterized by a chronic progressive course in the absence of treatment, and the goal of therapy is to achieve certain targets that depend in both cases on the “neglect” of the disease, as well as other factors. The relationship of disorders of purine metabolism and DM2 is shown by the results of large number of clinical studies. Taking into account the increasing incidence of both gout and DM2, paying attention to the fact that most of these patients are comorbid, the question of personification of therapy for these diseases is relevant. This review presents up-to-date data on the mechanisms of action and the effect on purine metabolism of the main groups of hypoglycemic drugs. Most drugs generally have a positive effect on urate metabolism, which is due to a direct or indirect effect on insulin resistance, and in some cases a specific mechanism of action of the drug. 

Introduction. Rehabilitation programs for patients with vertebral fractures (VF) with underlying osteoporosis (OP) include various methods. Pharmacological therapy should be prescribed to all patients who have undergone pathological VF with underlying OP to reduce the risk for future fractures.  

Objective. To study the effect of intravenous infusions of zoledronic acid at a dose of 5 mg once a year compared with oral bisphosphonates on long-term outcomes of rehabilitation in patients with vertebral fractures (VF) against the background of osteoporosis (OP) during a 2-year prospective follow-up.  

Materials and methods. 120 patients aged 40–80 years with systemic OP and PP were included, who were randomized into 2 groups. In group 1 (n = 60) a rehabilitation complex was prescribed with the inclusion of mechanotherapy and zoledronic acid 5 mg/100 ml – once a year, in group 2 (n = 60) – therapeutic exercises in the hall and pool and alendronic acid 70 mg orally 1 time per week. Dynamic follow-up of patients was 24 months.  

Results. Zoledronic acid was associated with higher adherence than alendronic acid, 83.0% versus 48.8% at 12 months (p = 0.0006) and 85.7% versus 56.3% at 24 months (p = 0.046). This contributed to the increase in BMD in the spine by 1.82% after 12 months (p = 0.045) and by 3.24% after 24 months (p = 0.038), in the femoral neck – by 2.45% (p = 0.029) after 24 months. In group 1, the intensity of the pain syndrome after 12 months (p = 0.003) was lower than in group 2, and the best indicators of quality of life (p < 0.05) were noted on the scales Pain, Mobility and State of mind, General health and in terms of total.  

Conclusion. Due to good adherence to treatment when prescribed once a year and a positive effect on long-term outcomes of medical rehabilitation, zoledronic acid can be recommended as a basic therapy for OP in patients with VF undergoing rehabilitation. 

Introduction. Eating disorders (ED) in obese patients dramatically reduce adherence to treatment and its effectiveness, which determines the importance of correcting ED.  

Aim. To evaluate the presence of various types of eating behavior (EB) in obese patients, the effect of sibutramine and liraglutide on EB, hunger and satiety to optimize individual treatment choice.  

Materials and methods. The study included 53 obese patients (BMI over 30 kg/m2), of whom 17 received liraglutide (3.0 mg/ day) and 36 – sibutramine (10 mg/day). The type of EB was determined using the Dutch Eating Behavior Questionnaire (DEBQ). The survey was conducted before and after 6 months of continuous treatment. The VAS scale was used to assess appetite. 

Results. The decrease in body weight, BMI, waist and hip circumference was statistically significant and comparable in the liraglutide and sibutramine groups (p < 0.001 for all parameters in both groups). Sibutramine showed a decrease in emotional eating behavior (EmEB) (p = 0.003), and liraglutide had no effect on EmEB. Treatment with sibutramine increased the severity of restrained eating behavior (REB) (p = 0.002); in the treatment group with liraglutide, there was only a tendency to decrease the score on the REB scale (p = 0.109). Liraglutide and sibutramine did not lead to statistically significant changes in external eating behavior (ExEB). Therapy with both sibutramine and liraglutide equally led to a significant reduction in hunger and the amount of food eaten.  

Conclusions. Liraglutide and sibutramine had a similar weight reduction effect, but they have different effects on EB indicators. Patients with EmEB may benefit more from sibutramine than from liraglutide. The more pronounced the violation of EB is in the patient, the more difficult it is to correlate. Questionnaires, for example DEBQ, can be used for an individual choice of treatment method. 

Currently, diseases of the thyroid gland (TG) have a high prevalence and a tendency to increase. The prevalence of thyroid hypofunction (overt and subclinical hypothyroidism) ranges from 1.5 to 10–15% in the general population. The clinical manifestations of hypothyroidism are diverse, with the defeat of the cardiovascular system (CVS) being the leading one in the clinical picture. Currently, most researchers attribute overt and subclinical hypothyroidism to risk factors for cardiovascular diseases: coronary heart disease, chronic heart failure, hypertension, atherosclerosis of the brachiocephalic and peripheral arteries, as well as the formation of metabolic syndrome. The article discusses in detail the pathogenetic mechanisms of the influence of thyroid hormone deficiency on the development of CVS diseases, as well as the characteristic changes detected during laboratory and instrumental research methods. Of interest are data on the effect of thyroid hypofunction on the development of arrhythmias, including atrial fibrillation. It is now known that the myocardium and vascular endothelium have receptors for thyroid hormones, triiodothyronine and thyroxine are involved in the expression of genes that control the processes of membrane depolarization and myocyte contraction, in the functioning of adrenergic pathways. The non-genomic effect of thyroid hormones on the cardiovascular system is manifested by the influence on the rate of entry of sodium and calcium ions through the myocyte membrane, on the potassium pumps of the sarcoplasmic reticulum, oxidative phosphorylation in mitochondria, and on peripheral vasodilation. The study shows that hypofunction of the thyroid gland affects the formation of CVS pathology also by influencing such factors of pathogenesis as hyper- and dyslipidemia, endothelial dysfunction, insulin resistance, the development of systemic inflammation, hyperhomocysteinemia, and obesity. The study of the thyroid hypofunction mechanisms influence on the CVS diseases formation is of great practical importance for their timely diagnosis, identification of risk factors and effective therapy. 

World achievements in the field of science, health technologies and socio-economic development at the turn of the XX–XXI centuries have increased the life expectancy of people. It is estimated that by 2050 the number of people over 60 will reach 2 billion people. In all countries, there is an increase in life expectancy with a disproportionately large increase in the number of elderly people. To solve the problems of aging-related diseases and reduce the burden on health systems, a better understanding of age-related diseases and methods of their diagnosis is required. Some of the diseases that accompany aging are sarcopenia and osteoporosis. As the body ages, bone loss occurs, in parallel with this, muscle strength decreases significantly (dynapenia), followed by a decrease in muscle mass (sarcopenia). Thus, osteoporosis (osteopenia) and sarcopenia are combined into a geriatric syndrome called “osteosarcopenia”, which is a common multifactorial musculoskeletal syndrome. Osteosarcopenia increases the risk of falls, fractures and hospitalization, leads to a deterioration in the quality and life expectancy of patients. The biology of osteosarcopenia is best understood in the context of systemic neuroendocrine and immune/ inflammatory changes that cause decreased autophagy and cellular aging in bone and muscle. To date, specific treatment of osteosarcopenia has not been developed, however, there are a number of preventive measures. Regular exercise, consumption of protein, calcium, vitamin D and prevention of falls and fractures are necessary to maintain the musculoskeletal unit and allow you to delay the onset of this condition. The article reflects the pathogenetic aspects, primary and secondary causes of osteosarcopenia, diagnostic criteria, methods of prevention and possibilities of drug therapy.

Violation of the intestinal microbiota is an important component in the pathogenesis of many chronic systemic diseases, which are based on chronic inflammation, changes in cytokine secretion, increased insulin resistance, microcirculation disorders, namely: obesity, diabetes mellitus (DM), atherosclerosis, chronic heart failure (CHF). The article clarifies the importance of the main intestinal metabolites: short-chain fatty acids (SCFAs), trimethylamine (TMA) and its oxide (TMAO) in the normal functioning of the “intestine – heart”, “intestine – liver”, “intestine – pancreas” axes, and also analyzes in detail the mechanisms of their dysfunction and the consequences of these disorders. The participation of the intestinal microbiota in the regulation of carbohydrate metabolism in patients with diabetes mellitus due to the activation of the synthesis of incretin hormones produced by the SCFAs (incretin effect) is considered. The role of lipopolysaccharide in the activation of proinflammatory cytokines and reduction of incretin response is shown. It was noted that violation of epithelial integrity leads to increased endotoxin intake into the blood, increased chronic inflammation, chronic dyscirculation and potentiation of atherosclerosis. A decrease in the content of butyrate-producing bacteria that provide anti-inflammatory mechanisms in the intestinal microbiota of CHF patients is an unfavorable factor that worsens the prognosis of the disease. An important modern aspect of cardiodiabetology is the study of the effect of intestinal dysbiosis on the production of a number of active metabolites, as well as the study of possible ways of pharmacological correction of existing disorders. It has been shown that probiotics can suppress inflammation, protect and restore the intestinal mucosal barrier, as well as improve intestinal function, which is important for the complex therapy of both diabetes and cardiovascular diseases. In DM, the use of incretin therapy, which contributes to the correction of the composition of the microbiota, is promising and pathogenetically justified. 

The article presents the results of an analysis of Russian and foreign sources on the prevalence of a new coronavirus infection COVID-19, describes the frequency and clinical course of post-covid disorders syndrome, the manifestations of which can persist for months. An important role in the recovery of patients with this syndrome is played by medical rehabilitation, which requires a multidisciplinary approach. Methods and technologies in the rehabilitation of patients who have undergone COVID-19 are diverse and covered in the works of many researchers around the world, and are also included in a number of clinical recommendations. This article describes the general principles for the rehabilitation of patients who have undergone a new coronavirus infection COVID-19, incl. the use of a complex of respiratory gymnastics – rehabilitation exercises designed for diseases of the respiratory system, training and exercises to strengthen the respiratory muscles, including the intercostal and abdominal wall muscles; the use of virtual reality technologies, the use of which can be an effective way to improve the functionality and quality of life of patients; the use of hardware mechanotherapy with biofeedback (physiological or biomechanical types), which allows you to correctly dose the load and the accuracy of the exercises, more actively involve patients in the process and minimize the need for constant monitoring. The combination of traditional approaches with VR technologies and mechanotherapy with biofeedback can further enhance the effects of rehabilitation in this category of patients. Data are presented on the complex method for the rehabilitation of patients with post-COVID syndrome developed at the Federal State Budgetary Institution “National Medical Research Center for Rehabilitation and Balneology” of the Ministry of Healthcare of the Russian Federation, which has the highest efficiency and prospects for use, which helps to reduce the severity of manifestations of the post-COVID syndrome, reduces the risks of undesirable outcomes, and improves the quality of life of patients.