Dear Colleagues!We are glad to present the 12th (revised) Edition of the Standards of Specialized Diabetes Care.These evidence-based guidelines have been designed to standardize and facilitate diabetes care in all regions of the Russian Federation.The Standards are regularly updated to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization (WHO), the Russian Association of Endocrinologists (RAE), the International Diabetes Federation (IDF), the European Association for the Study of Diabetes (EASD), the American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), the International Society for Pediatric and Adolescent Diabetes (ISPAD), as well as the results of completed randomized clinical trials in patients with DM.The number of people with diabetes in the world has increased threefold over the past 20 years. In 2024, according to the International Diabetes Federation (IDF Atlas, 11th Edition, 2025), the number of people with diabetes in the world was 588.7 million people, 40% of whom were not diagnosed in time. More than 1 billion people have prediabetes (impaired glucose tolerance and/or impaired fasting glucose). Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to the data of the Endocrinology Research Centre, obtained on the basis of the analysis of the “Clinical and Epidemiological Monitoring Database” (https://www.diaregistry.ru/) there were 5,814,928 people with DM in our country (3.9% of the population) on 01.01.2026: 92.3% (5,366,995) — type 2 diabetes mellitus, 5.3% (308,605) — type 1 diabetes mellitus and 2.4% (139,328) — other types of diabetes, including 20,982 women with gestational diabetes.However, these data underestimate the real number of patients, because they consider only registered cases of DM. Results of the Russian epidemiological study (NATION) confirmed that 54% of type 2 diabetes cases were undiagnosed. Thus, the real number of patients with diabetes in the Russian Federation is at least 11–12 million people (about 7% of the population). This represents an extreme threat. The most dangerous consequences of the global epidemic of diabetes are systemic vascular complications — nephropathy, retinopathy, coronary artery disease and peripheral vascular disease. These complications are responsible for the majority of cases of diabetes-related disability and death.This edition preserves the individualized approach to the selection of treatment goals in patients with diabetes and the choice of antihyperglycemic therapy. The most important updates:Type 2 Diabetes Mellitus remission criteria. Information on ICD-10 code E11.A has been added to indicate remission of type 2 diabetes in patients without complications.Type 2 Diabetes Mellitus. Treatment.Information on drugs available in the Russian Federation has been updated.In patients with ASCVD, tirzepatide (a dual GIP/GLP-1 receptor agonist) is considered as one of preferred options (based on the results of the SURPASS-CVOT study, which assessed the effect on cardiovascular risk compared to dulaglutide).The section on insulin therapy examines the possibilities of its deintensification; comments are provided for clarifying the role of concentrated insulin forms and ultra-rapid-acting insulins.Monitoring of patients with T2DM. HbA1c monitoring may be reduced to once every 6 months in patients who have consistently achieved target glycemic control (in patients without hypoglycemia or factors that could potentially distort HbA1c).Prevention of T2DM. A fasting plasma glucose level ≥ 6.1 mmol/L has been added as a criterion for the greater expected efficacy of metformin as the agent for pharmacological prevention.Diabetic nephropathy in T2DM. In antihyperglycemic therapy, SGLT2 inhibitors are prioritized due to their proven benefits in reducing the risk of CKD progression and cardiovascular events.Diabetic neuropathy. Visual materials with methods for assessing tactile and vibration sensitivity have been added.Diabetes and Heart Failure. Information has been added on the use of GLP-1 RAs (GLP-1 /GIP RAs) in patients with type 2 diabetes, obesity and heart failure.Diabetes mellitus and dyslipidemia. This section is presented as a separate part of manuscript for the first time. The feasibility of testing lipoprotein (а) levels for all patients to clarify cardiovascular risk once during life once during life has been determined. The position of bempedoic acid has been clarified for the first time. Approaches to the treatment of hypertriglyceridemia have been updated.Diabetes mellitus in children and adolescents. Type 1 diabetes mellitus. Glycemic targets have been revised according to ISPAD, 2024.Epidemiological data on diabetes mellitus in the Russian Federation have been updated.Some inaccuracies have been corrected.“Standards of Specialized Diabetes Care” have been a reference book for almost a quarter of a century not only for endocrinologists, but also for a wide range of doctors of other specialties. The advantages of the “Standards” are a concise, structured and visual presentation of information, and due to regular updates, every 2 years, a quick presentation of the most relevant data. This is the result of the work of a large team of authors and therefore allows us to cover a wide range of problems of patients with such a heterogeneous disease as DM.The working group draws attention to the fact that the information contained in the “Standards of Specialized Diabetes Care” reflects the key positions of approved clinical guidelines, but at the same time the “Standards” are not regulatory legal documents mandatory for execution in the territory of the Russian Federation, but are generally informational and advisory in nature. Legally binding documents that have priority are the current versions of the relevant clinical recommendations posted in the rubricator of the Ministry of Health of the Russian Federation (https://cr.minzdrav.gov.ru).On behalf of the Working Group
Metabolic diseases are currently significant factors of disability and mortality in the Russian Federation. Modern pharmacology offers many tools for glycemic control, but their effects on weight loss in patients are limited. There is currently no therapy for lipodystrophies except for symptomatic therapy. In this regard, the development of tissue engineering in combination with genetic technologies is a key factor in creating new approaches to the treatment of metabolic diseases. The presented review article describes various approaches to tissue engineering for the formation of grafts of adipocyte origin. Today, a variety of cells are used for these purposes — these are adipose-derived mesenchymal stromal cells (ADSC), which are progenitors of mature adipocytes and components of the cellular niche of adipose tissue, and metabolically healthy adipocytes, and thermogenic adipocytes. Cells are used both in a native state and can be genetically modified. The presented review integrates knowledge about transplantation of various adipose tissue derivatives in different tissue-engineered formats for the treatment of major metabolic diseases, which include lipodystrophies, obesity, and type 2 diabetes mellitus. The results of the review can give a significant impetus to the development of new approaches to the treatment of metabolic diseases.
BACKGROUND: The problem of achieving target glycemic control in patients with diabetes mellitus type 1 (T1DM) remains relevant. Currently, new, more technologically advanced methods of insulin therapy (IT) are being actively developed — one of them is the IT method of a closed loop (do-it-yourself closed loop system, DIY-CLS). This type of therapy is not registered in Russia, however, patients install these systems themselves, in connection with which it seems important to discuss the principle of DIY-CLS operation, the possibilities and prospects of their use.OBJECTIVE: To evaluate the glycemic control indicators, the frequency of acute complications of diabetes in patients with type 1 diabetes on different types of therapy.MATERIALS AND METHODS: We observed 98 patients who were divided into 3 groups: patients using MII (n=40), patients with CSII (n=40) and patients with DIY-CLS (n=18). All groups were comparable in age, sex and the duration of T1DM history.RESULTS: The majority of patients were women (73.47%), the average age was 33.3±2.4 years, the duration of diabetes was 17.1±2.2 years. It was found that in patients from the DIY-CLS group, compared with the MII and CSII groups, according to continuous glucose monitoring, the time in range was significantly higher, the mean glucose, standard deviation, time above range 10.1–13.9 mmol/l and time above range >13.9 mmol/l were significantly lower. The number of hypoglycemic states and hyperglycemic events leading to the development of ketosis was comparable.CONCLUSION: Glycemic control values were significantly better in patients using DIY-CLS. Patients in the DIY-CLS group more often achieved target time above range and coefficient of variation levels.
BACKGROUND: Type 2 diabetes mellitus (T2DM) is one of the major risk factors for severe COVID-19 and increased mortality. The long-term consequences of the infection remain unclear.AIM: To assess mortality and risk factors for death in patients with T2DM after COVID-19, both in acute phase and long-term follow-up.MATERIALS AND METHODS: This was a retrospective observational case-control study. Study included patients over 18 years of age with T2DM and recorded history of COVID-19 in clinical-epidemiological diabetes monitoring database from 2020 to 2022. Control group consisted of patients with T2DM who died between 2020 and 2022 from causes not related to COVID-19. Statistical analysis performed using RStudio 2024.04.02 (Posit Software, PBC) with R programming language, version 4.3.3.RESULTS: The study included 7,625 patients with T2DM who had recovered from COVID-19 and 212,352 patients with T2DM without a documented history of COVID-19. From 2020 to 2022, the mortality rate in the post-COVID group was 24.6%, of which 21.7% occurred during the acute phase. This was significantly higher than in the control group (14.1%, p<0.001).In the long-term period after COVID-19, the following factors were associated with increased mortality risk: older age (OR 1.06; 95% CI 1.04–1.07, p<0.001), longer diabetes duration (OR 1.03; 95% CI 1.01–1.05, p<0.05), and older age at diabetes onset (OR 1.04; 95% CI 1.02–1.05, p<0.001).A lower risk of death in the long-term period was associated with the use of SGLT2 inhibitors (HR 0.45; 95% CI 0.29–0.70, p<0.001) and metformin (HR 0.40; 95% CI 0.30–0.54, p<0.001).CONCLUSION: Mortality was higher among patients with history of COVID-19 compared to control group. Increase in mortality was primarily due to deaths in acute phase of infection. After adjusting for sex, age, following factors were independently associated with increased long-term mortality in T2DM patients after COVID-19: older age, male sex, insulin therapy. Protective factors included use of SGLT2 inhibitors and metformin.
