Diabetic nephropathy (DN) is a serious complication of diabetes mellitus (DM), which increases morbidity and mortality. Accumulated evidence, mostly experimental ones that DPP-4 inhibitors have non-glycemic tissue effects including renal protection. Clinical data confirming these effects are insufficient. This makes it relevant to study the influence of iDPP-4 on the renal function in patients with Type 2 diabetes.

To study the effects of iDPP vildagliptin on glycemic, metabolic and renal parameters in patients with type 2 diabetes with CKD 1–2 receiving insulin therapy 44 patients were randomized to continue therapy with insulin or insulin + vildagliptin at a dose of 50 mg/day, with the evaluation of results in 6 months.

In group of vildagliptin therapy a significant decrease of HbA1c, postprandial glycemia, diastolic blood pressure, HOMA-IR, insulin demand and a reduction in the frequency of hypoglycemia occurred. The positive dynamics of indicators of glomerular functions of the kidney were noted in this group - a significant reduction in albuminuria and a significant increase in eGFR by cystatin C and decreased urinary excretion of type IV collagen. The findings suggest the positive effect of vildagliptin on metabolic status and indicators of glycaemia and hemodynamics as earlier confirmed in clinical studies and the ability of vildagliptin independent from glycemic effects to slow the development of glomerular dysfunction in patients with type 2 diabetes and the initial manifestations of DN. 

Diabetes mellitus implies the need for self-monitoring under the supervision of the attending physician. In the conditions of increasing prevalence of diabetes, the physician’s key task is to properly educate the patient in applying the main principles of self-monitoring. Learning the principles of glycemic control with a portable glucometer is an essential component of diabetes treatment.

A new approach to the treatment of the Type 2 diabetes mellitus (T2DM) based on drug-induced glycosuria and reduction in renal threshold of glucose, and drugs with a similar mechanism of action belong to an innovative class of antidiabetic drugs: inhibitors of 2nd type sodium-glucose cotransporter (GLT-2). In addition to improving glycemic control SGCT-2 inhibitors promote moderate weight loss and blood pressure (BP), increased sensitivity of tissues to insulin and improve β-cell function. Dapagliflozin an oral SGCT-2 inhibitor, which is due to the insulin independent mechanism of action is characterized by the minimal risk of hypoglycemia compared to traditional antidiabetic drugs, such as sulfonylurea and insulin. For this reason, the drug has the unique ability to combine with other oral hypoglycemic agents (OHGA). In addition, due to its natriuretic effect and ability to reduce body weight and blood pressure dapagliflozin is the drug of choice in patients with T2DM and cardiovascular diseases of atherosclerotic genesis. A combination of advantages, including a favorable safety profile of dapagliflozin allows extensive use of this drug for the initiation and intensification of T2DM treatment.

Type 2 diabetes is a chronic progressive disease the prevalence of which is increasing. The development of new strategies for the treatment of diabetes, among which drugs that modulate the “incretin effect” are worth noting, continues. Dipeptidyl peptidase-4 inhibitors (DPP-4, gliptins) are a group of oral antidiabetic incretin drugs that enhance the glucose-induced activity of β-cells and suppress excessive glucagon secretion by pancreatic α-cells. This group of antidiabetic drugs is widespread due to a number of relevant benefits, such as neutral effect on body weight, low risk of hypoglycaemia, convenient administration scheme and good adherence to treatment. Efficacy and safety of treatment demonstrated by global multicenter trials allow for a wide use of gliptins in clinical practice.

In today’s clinical practice, the treatment of type 2 diabetes mellitus should be targeted not only at achieving glycemic control, but should also affect other modified risk factors for cardiovascular disease including hypertension, overweight, frequent hypoglycemia, etc. [4] Empagliflozin is the first antidiabetic drug with the new approved indication allowing it to be used for the reduction of cardiovascular mortality risks in patients with type 2 diabetes and comorbid cardiovascular diseases.

Angiogenesis factors, growth factors (vascular endothelial growth factor (VEGF), angiopoietin-2, insulin-like growth factor, etc.) and cytokines play the leading role in the production by endothelial cells of new retinal blood vessels, increased vascular permeability resulting in exudation and macular edema leading to the development of irreversible complications and vision loss. Although large-scale clinical trials demonstrated that tight control of glycemia and normalization of systemic blood pressure reduce the risk of progression of diabetic retinopathy (DR), the relationship between lipid disorders and retinal damage is not fully understood.

The focus on the problem of diabetes mellitus (DM) is associated with the increasing prevalence of the disease and the risk for the development of many vascular complications (nephropathy, retinopathy, lesions of the great vessels of the heart, brain, peripheral vascular disease of the lower limbs), in the development of which chronic hyperglycemia plays a crucial role. In 2011, the WHO decided that glycated hemoglobin (HbA1c) could be used as the diagnostic criterion for diabetes. The role of HbA1c in the choice of hypoglycemic therapy is invaluable. According to the Algorithms of Specialized Medical Care for Diabetes Mellitus Patients, stratification of treatment strategy in patients with newly diagnosed type 2 diabetes is determined by the initial HbA1c.

In article the most often arising diseases from skin are described and a mucosa of an oral cavity at patients with a diabetes mellitus: mechanisms of their emergence, prophylaxis methods.

Obesity is a chronic disease associated with cardiometabolic risk factors of cardiovascular diseases and type 2 diabetes. In 2016, in Russia a new drug was registered for the treatment of patients with adiposity - liraglutide 3.0 mg, which is an analog of human glucagonoma peptide-1. The study purpose: to study the efficacy of liraglutide 3.0 mg/day and its impact on cardiometabolic risk factors in patients with obesity. We examined 30 patients aged 25-59 with obesity without diabetes. Patients received therapy with liraglutide 3.0 mg/day for 3 months. The examination included measurement of anthropometric parameters, blood sampling with the estimation of the parameters of lipid and carbohydrate metabolism.

Results: after 3 months of treatment with liraglutide 3.0 mg a significant improvement of anthropometric parameters was observed: reduction of weight, BMI and waist circumference and a significant improvement in parameters of metabolic comorbidities.

Conclusions: complex therapy with use of liraglutide 3.0 mg per day for 3 months is effective for therapy of obesity and correction of obesity-associated cardiometabolic disturbances. 

Secondary hypothyroidism is a very rare cause of hypothyroidism in adults. Clinical manifestations of secondary as well as primary hypothyroidism are nonspecific; in addition, thyroid hormone deficiency often clinically simulates other tropic hormone deficiencies, thus complicating timely diagnosis of the disease. Certain difficulties are also caused by replacement therapy in secondary hypothyroidism, since the level of free thyroxine in the blood is used as the criterion for evaluating levothyroxine dosage, and questions about the use of peripheral markers of thyroid function to assess the adequacy of therapy remain understudied.

Over the past years, the focus has been growing on the prevention and treatment of obesity. Obesity has long been considered not just as excess body fat but as a chronic relapsing disease, the result of energy disbalance, which develops with an increase in food intake and reduced energy expenditure and is closely associated with a number of serious complications. Orlistat (Xenical), a peripherally acting drug without systemic effects [11, 24, 27], has been widely used in pharmacological treatment of obesity. Xenical is the most well-studied medication for weight loss. More than 30,000 patients with obesity were involved in clinical trials, of which over 2,500 patients had type 2 diabetes. Till today, the drug remains a breakthrough in the treatment of overweight/obesity.

Acromegaly is a disease with multiple organ failure. Furthermore, acromegaly is frequently accompanied by psychological disorders, with a significant decrease in the quality of life. Neurosurgical treatment (transsphenoidal adenomectomy) is recommended as first-line treatment for most patients with acromegaly. According to the recent guidelines, patients after surgery who failed to achieve biochemical control should receive pharmacotherapy. [1, 2, 6] If radical removal of somatotropinoma is unlikely (for an invasive tumor that spread outside the sella, 20 mm or more in size) and there are no strict indications for surgery, many global experts recommend somatostatin analogues as the first-line treatment, which are the absolute leaders among drugs for the treatment of acromegaly.

Among comorbidities of obesity, hypothyroidism is the most common endocrinopathy. The pathogenesis of both diseases is based on serotonin deficiency. The article tells about a clinical case of a patient with obesity and subclinical hypothyroidism; a comprehensive examination allowed to choose the efficient and safe pathogenetic therapy.

One of the most important parameters of health in children is growth. Stunted growth leads to the development of inferiority complex in patients and often hampers social self-realization. Over the past two decades, the Republic of Tatarstan has been actively diagnosing and treating growth hormone deficiency in children with short stature. Children with isolated growth hormone deficiency receive monotherapy with recombinant growth hormone. Early treatment of children with growth hormone deficiency led to an improvement in anthropometric parameters and, consequently, psychological and social adaptation of this group of patients.

Aim. To prove that formally low incidence and frequency of diabetes insipidus (ND) and other variants of syndrome poliuriapolydipsia (SPP) did not reflect the true prevalence and clinical significance of such disturbances.

Material and methods. Demonstrated etiology and pathogenesis diversity of SPP, difficulties in its classification and diagnosis.

Results and conclusions. Proposed diagnostic and therapeutic approaches. 

Hyperglycemia is a major cause of complications in patients with diabetes mellitus (DM). Since the optimal level of glycemic control is achieved only in a small number of patients with diabetes mellitus, additional methods of prevention and treatment of complications are strongly recommended. The focus of healthcare specialists is increasing on substances that can affect intracellular pathological processes associated with hyperglycemia. Such drugs or agents include certain vitamins and minerals.

«Donat Mg» is highly mineralized sulphate-hydrocarbonate sodium-magnesium water with unique healing properties. It course intake not only promotes normalization of the gastrointestinal tract, but also prevents cardiovascular disease, having a positive effect on the status of carbohydrate, protein and fat metabolism.

Atherosclerotic cardiovascular diseases substantially have contributing to mortality and structure of disability in developed countries. Metabolic syndrome is a cluster of clinico-biochemical changes with the most aterogenic potential.

Objective: to determine trends of early stages of metabolic syndrome and its relationship with the initial atherosclerosis in young and middle-aged men. Have been examined 436 men with an assessment symptoms of metabolic syndrome, as well as signs of subclinical atherosclerosis. The young men with initial manifestations of metabolic syndrome were characterized by the classical cardiovascular risk factors. According to the results of the study have been already diagnosed dyslipidemia, violation of apolipoproteides fractions, postprandial hyperglycemia at the initial stage of metabolic syndrome in this category of patients. have been proposed assessment of waist circumference, degree of diastolic blood pressure and postprandial glycemia as the most sensitive diagnostic markers of cardiovascular lesions in primary manifestations of metabolic syndrome.