Database of patients with diabetes mellitus (Federal Register of Diabetes Mellitus) allows to track changes in the epidemiological parameters of a cohort of patients with diabetes mellitus (prevalence, morbidity), to assess indicators of glycemic control, prevalence of complications and concomitant diseases, as well as long-term dynamics. The data obtained allow assessing the quality of medical care in Moscow in general and in individual districts and medical institutions, and to plan measures to improve glycemic control and reduce the risk of developing complications of diabetes mellitus.

Objective. To consider modern means of monitoring glycemia using a mobile application that allows remote control of diabetes mellitus (DM). The main provisions. The problem of self-control of DM in the modern world does not lose relevance. Recommendations on the management of patients with DM are updated annually. New approaches to self-monitoring of glycemia are being developed, innovative glucose meters are being introduced, which are a system with a mobile application.

Introduction. Timely differential diagnosis between densely and sparsely granulated somatotrophic tumors allows predicting the most probable scenario of acromegaly course, receptor phenotype and proliferative potential of tumor cells, risk of continued postoperative growth, as well as the efficacy of planned drug therapy with first-generation somatostatin receptor ligands.Aim. To validate cytological, radiological and therapeutic predictors allowing to evaluate the morphofunctional composition of somatotrophic tumors and to predict sensitivity to first-generation somatostatin receptor ligands.Materials and methods. 525 patients (153 men) aged 60.2 ± 14.0 years receiving drug therapy with first-generation somatostatin receptor ligands for 72.0 ± 51.9 months were examined.Results. Treatment efficacy was evaluated according to the final level of IGF-1 index (≤1) and compared with the data of pathomorphologic (97 patients) and repeated radiologic (53 patients) examination. The influence of cellular composition of densely and sparsely granulated somatotrophic tumors on immunohistochemical and radiologic characteristics with the designation of leading predictors of morphologic identification of somatotrophic tumors was investigated. Additional radio markers for quantitative assessment of relative intensity of tumor signal on T2-, T1and (T2-T1)-weighted MRI for non-invasive differential diagnostics of densely and sparsely granulated somatotrophic tumors and determination of optimal treatment tactics were proposed. The expediency of using pharmacotherapeutic testing with short-term (3–6 months) first-generation somatostatin receptor ligands administration to assess the intactness of receptor and postreceptor mechanisms and to choose optimal drug therapy was substantiated.Conclusion. The precision approach based on comprehensive clinical, radiological, pathomorphological and functional characteristics allows stratification of patients with acromegaly to optimize treatment benefit. Achievement of acromegaly control in drug therapy with first-generation somatostatin receptor ligands depends on tumor volume and its hormonal activity, absolute and relative expression of the 2nd subtype of somatostatin receptors, severity of destructive changes and features of cellular composition. In case of refractoriness to first-generation somatostatin receptor ligands, the use of pegvisomant is expedient.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

AIM: To assess the prevalence of chronic kidney disease (CKD), clinical and demographic characteristics and therapy profile in patients with type 2 diabetes admitted to multidisciplinary hospitals. CREDO (Cardio-REnal Diabetic cOmplications) trial was initiated for this purpose.MATERIALS AND METHODS: in a prospective observational multicenter study for the period from August 2022 to April 2023, data from 445 patients with type 2 diabetes hospitalized in multidisciplinary hospitals of the Moscow Department of Health were analyzed. The data was collected on a single visit. The design of the study did not involve any interventions in routine clinical practice, including the choice of a diagnostic or treatment method.RESULTS. The study included 445 patients with the main inclusion criteria — type 2 diabetes, age over 50 years, duration of diabetes more than 3 years. The prevalence of CKD was 90%, while in 43% the diagnosis of CKD was confirmed, in 43% it was detected for the first time, and in 7% the disease progressed. Patients with stage C2 and C3 (a and b), as well as with levels of A1 and A2 albuminuria, were most often identified. The percentage of patients in whom the albuminuria was not performed remained high — 46.2%. The highest incidence of CKD was observed in patients with inadequate glycemic control, having an HbA1c level of ≥9%. In the group with newly diagnosed CKD, sodium-glucose co-transporter-2 inhibitor (iSGLT-2) was received by 31.1% of patients, glucagon-like peptide-1 receptor agonists (GLP-1 RA) — 7.9% of patients. In the group with confirmed CKD — 30.7% and 9.4%, respectively.CONCLUSION: it has been shown that patients over the age of 50 with type 2 diabetes with a disease duration of more than 3 years are at a high risk of developing CKD — 90%. The results obtained convincingly confirm the possibility of detecting CKD and initiating nephroprotective therapy at the hospital stage.

BACKROUND: Heart failure (HF) is in the first place in the structure of cardiovascular death in patients with type 2 diabetes mellitus (T2D). One of the factors determining the prognosis of patients with this pathology is hospitalization. The difficulties of managing patients are related to the heterogeneity of the population. In some cases, HF in patients with T2D remains undiagnosed, and data on the true frequency of HF in patients with T2D and their clinical and laboratory characteristics in real clinical practice remain limited.AIM: To assess the prevalence of HF, clinical and demographic characteristics and therapy profile in patients with T2D admitted to multidisciplinary hospitals.MATERIALS AND METHODS: A prospective observational multicenter study was conducted at the city clinical hospitals of the Moscow. For the period from August 2022 to April 2023, data from patients with T2D were analyzed. Data collection was carried out at one visit. The study design did not involve any intervention in routine clinical practice, including the choice of diagnostic method or treatment.RESULTS: The study included 445 patients in accordance with the main inclusion criteria - T2D, age over 50 years, duration of T2D more than 3 years. The incidence of HF in patients with type 2 diabetes at discharge was 76.6%. The diagnosis of HF was confirmed in 48.7% (n=217), newly diagnosed HF occurred in 27.9% (n=124) of cases, in 12.6% of patients (n=56) the diagnosis of HF was withdrawn, in 10.8% (n=48) of cases the diagnosis of HF was not established. The frequency of prescribing drugs at discharge was iSGLT-2 — 77.3% (n=344), statins — 86.7% (n= 386), MRAs — 23.1% (n=103), diure­tics — 46.1% (n=205).CONCLUSION: 76.6% of patients with T2D admitted to multidisciplinary Moscow hospitals were diagnosed with HF at discharge. The results obtained confirm the possibility of detecting HF and initiating cardioprotective therapy at the hospital stage, using inpatient clinical diagnostic examination, and patients with type 2 diabetes lasting more than 3 years and aged over 50 years can be classified as a high risk group for developing HF.

Due to the syndromal nature of acromegaly, the effectiveness of its treatment depends on the consideration of age, clinical and pathomorphological features of the disease, which determine the logistics of the selection of personalized therapeutic measures. The disadvantage of the used empirical pharmacotherapy scheme with the help of the ‘trial and error’ method is the formal prescription of drugs without taking into account the peculiarities of the morphofunctional status of the supervised GH-secreting tumors and the targeting of drugs. The lack of differentiated approach to acromegaly treatment is accompanied by a high percentage of therapeutic failures, and also deliberately deprives a significant proportion of patients of the opportunity to achieve timely and safe control of the disease and improve the quality of life. The review presents a comparative analysis of modern drugs used in acromegaly with a focus on the clinical efficacy of the second-generation somatostatin receptor ligand – pasireotide. The mechanism of action and pharmacotherapeutic possibilities of pasireotide LAR are considered. The therapeutic niche for this drug is patients with the presence of sparsely granulated somatotrophic tumor (SGST), characterized by aggressive course, tendency to recurrence and refractoriness to therapy with first-generation somatostatin receptor ligands.Implementation of a precision approach using clinical, morphological, radiological and functional predictors allows not only to identify the specific morphotype of somatotrophic tumor, but also to predict the efficacy of the planned treatment. A table of multidirectional biomarkers of long-term sensitivity of tumor cells to first- and second-generation somatostatin receptor ligands is presented. When SGST, large size of the residual tumor and poor expression of the 2nd subtype of somatostatin receptors are detected, pasireotide LAR can be used as a 1st-line treatment, in both mono- and combination therapy with pegvisomant. Special caution is required when treating patients with diabetes mellitus or predisposition to its development. The paper discusses in detail the measures aimed at prevention, dynamic control and correction of pasireotide-associated hyperglycemia.

An erratum on « Insufficiency/deficiency of vitamin B12 in patients in the endocrinological practice» by Natalya G. Mokrysheva, Marina V. Shestakova, Alexander S. Ametov, Mikhail B. Antsiferov, Igor G. Bakulin, Tatiana V. Vavilova, Gagik R. Galstyan, Tatiana Y. Demidova, Fatima K. Dzgoeva, Tatiana L. Karonova, Elena A. Lukina, Ashot M. Mkrtumyan, Rodion V. Ponomaryov, Natalia A. Suponeva, Olga Y. Sukhareva, Minara S. Shamkhalova (2024). Diabetes mellitus. 27(3). doi: 10.14341/DM13181An error was made in the list of authors: Nina A. Petunina was not indicated as author of this article. The correct list of authors: Natalya G. Mokrysheva, Marina V. Shestakova, Alexander S. Ametov, Mikhail B. Antsiferov, Igor G. Bakulin, Tatiana V. Vavilova, Gagik R. Galstyan, Tatiana Y. Demidova, Fatima K. Dzgoeva, Tatiana L. Karonova, Elena A. Lukina, Ashot M. Mkrtumyan, Nina A. Petunina, Rodion V. Ponomaryov, Natalia A. Suponeva, Olga Y. Sukhareva, Minara S. Shamkhalova.The identifier in the ORCID system for F.K. Dzgoeva was also indicated incorrectly. The correct link is: https://orcid.org/0000-0002-0533-7652.The editorial board apologize for this error and state that this does not change the scientific conclusions of the article in any way.The original article has been updated.

On March 20, 2024, an interdisciplinary meeting of the Expert Council on the current problem of B12 insufficiency/deficiency and the prevalence of this condition among endocrine patients was held at the Endocrinology Research Centre (Moscow). The purpose of the meeting was to assess the role of B12 deficiency in reducing the quality of life of patients of different groups and to outline a strategy for the management of patients with vitamin B12 insufficiency/deficiency by endocrinologists.The resolution of the expert council was developed by leading specialists in various specialties.

The article provides information on concomitant conditions of type 2 diabetes mellitus such as cardiovascular diseases, sleep apnea syndrome. Questions about the types of sleep breathing disorders and factors predisposing to this condition are discussed. Data on the prevalence of sleep apnea in the world are demonstrated. The main approaches to the diagnosis of this condition are shown. Differences in therapy approaches for obstructive sleep apnea and central sleep apnea have been demonstrated. The issues of the relationship between obstructive sleep apnea, type 2 diabetes mellitus and cardiovascular diseases are considered. The data of clinical studies evaluating the relationship of sleep apnea and cardiovascular diseases are presented. Their mutually aggravating influence is shown. Information is provided on the effect of sleep apnea on the main clinical outcomes according to clinical research data. The relationship between sleep apnea and heart failure is discussed. The main issues of the inflammatory profile of sleep apnea are discussed, which are closely related to cardiovascular diseases and type 2 diabetes and include: macrophage recruitment and inflammatory biomarkers such as C-reactive protein, chemokines and cytokines such as interleukin 6, tumor necrosis factor α, nuclear kappa factor B, as well as adhesion molecules such as selectins, intracellular adhesion molecule-1 (ICAM-1) and intracellular vascular adhesion molecule (VCAM-1), imbalance between prooxidant and antioxidant factors. These factors contribute to the development of microvascular and macrovascular complications in type 2 diabetes mellitus. Special attention is paid in the publication to the discussion of the main factors predisposing to the development of sleep apnea in heart failure in patients with type 2 diabetes mellitus. The data on the main diagnostic tests for patients with heart failure and type 2 diabetes are presented. Information is provided on the use of drugs from the group of sodiumglucose cotransporter type 2 inhibitors in patients with type 2 diabetes and sleep apnea syndrome. Reasonable recommendations on the use of these drugs are presented, taking into account the modern strategy for the treatment of type 2 diabetes.

BACKGROUND : Value of diabetes mellitus as social and medical issue seems to be growing worldwide. High rates of concomitant cardiovascular disease represent significant problem for prognosis improvement in diabetes mellitus patients. During analysis of CARDIA-MOS study results overall mortality decrease of 38.6% was demonstrated for sodium-glucose cotransporter-2 dapagliflozin. AIM : To analyze the number of added life years in patients receiving dapagliflozin compared to patients who did not receive hypoglycemic treatment with cardioprotective effects. MATERIALS AND METHODS : To evaluate outcome rates in patients included in CARDIA-MOS register, two samples were formulated according to predetermined criteria: 1) patients who started dapagliflozin treatment in 2017 and received medication for 48 months; 2) control group of patients not receiving cardioprotective hypoglycemic treatment comparable to study group in key characteristics: age, duration of diabetes mellitus, presence of cardiovascular disease, use of insulin, glycated hemoglobin (HbA1c) levels. RESULTS : Dapagliflozin increased life expectancy. Earlier prescription of treatment was associated with larger difference compared to standard therapy. For patients aged 60 years old dapagliflozin added 3.7 years of life, while in patients aged 75 years — 1.4 years. Demonstrated trend was consistent in analysis using locally weighted scatterplot smoothing. CONCLUSION : Therefore, use of dapagliflozin in real clinical practice was associated with increase in life expectancy. Earlier start of treatment led to higher number of life years added.

BACKGROUND : When developing programs for state reimbursement of the cost of medical services and medicines, when providing assistance to patients suffering from type 1 diabetes mellitus (DM1), data based on the results of pharmacoepide-miological studies (FEI) conducted in real clinical practice of treating patients are needed. The obtained results of the analysis of drug consumption allow us to study the most commonly used insulin therapy regimens and their compliance with modern clinical recommendations. Calculations of the weighted average cost of conducting hypoglycemic therapy in DM1 can be used for further pharmacoeconomical calculations, including analysis of the medical and social cost of the disease. AIM : To conduct a pharmacoepidemiological analysis of the consumption of insulin preparations according to the ATX /DDD methodology, to study the modes of insulin administration and the ratio of the weighted average cost of insulin therapy components per 1 patient with DM1 per year in the outpatient practice of treatment with the introduction of insulin in the mode of multiple injections of insulin (MII) and during continuous subcutaneous insulin infusion (CSII). MATERIALS AND METHODS : A retrospective continuous cohort analytical pharmacoepidemiological study was conducted on the basis of the SRDM database (status as of 01/01/2020), in which 17,617 patients with T1DM aged 18 years and older were registered at the time of the study. RESULTS : 90% of patients received analogues of human insulin in the MII mode using syringe pens, 8.6% used the CSII mode. In 34.5% of patients with DM1 HbA1c was <7%, the proportion of patients with HbA1c >8% was 28%. The average cost of insulin therapy per 1 person per year was 54,977 rubles. The cost of basal insulin treatment per 1 patient per year was approximately 1.5 times higher than the cost of bolus insulin during insulin therapy in the MII mode (33,960 rubles and 21,017 rubles, respectively). The weighted average cost of insulin per 1 patient per year for CSII was 31,822 rubles. CONCLUSION : The majority of patients with DM1 in the study cohort received analogues of human insulin in the basic bolus mode of MII using syringe pens, which corresponds to existing clinical recommendations. The proportion of patients achieving the goals of glycemic control is comparable to the data obtained on the basis of registers of diabetic patients in other economically developed countries

Diabetes is disease of both the endo- and exocrine parts of the pancreas. Pancreatic exocrine insufficiency (PEI) can occur in every 2–3 patients with diabetes and affect not only the quality, but also life expectancy. At the same time, the diagnosis and treatment of PEI is not getting enough attention. The endocrinologist, as the main specialist leading patients with diabetes, can diagnose and treat patients with pancreatic exocrine insufficiency and diabetes using adequate doses of pancreatic enzyme replacement therapy (PERT).

The progressive improvement of the classification using modern analytical methods is an essential tool for the development of precise and personalized approaches to the treatment of pituitary adenomas. In recent years, endocrinologists have witnessed evolutionary changes that have occurred in the histopathological identification of pituitary neoplasms, revealing new possibilities for studying tumorigenesis and predicting biological behavior. The paper considers the historical aspects of the gradual improvement of the classification of pituitary adenomas, as well as the new international 2022 WHO classification, according to which pituitary adenomas are included in the list of neuroendocrine tumors (PitNETs) to reflect the biological aggressiveness of some non-metastatic pituitary adenomas. The characteristics of pituitary adenoma are presented, as well as a list of histological subtypes of aggressive neuroendocrine tumors of the pituitary gland, marked by the main potentials for invasive growth, an increased risk of recurrence and a negative clinical prognosis. The expediency of changing the definition of «pituitary adenoma» to «neuroendocrine tumor» is discussed. It is emphasized that the introduction of a unified clinical, laboratory and morphological protocol into national clinical practice will help provide comparable comparative studies on the prognosis of the disease and the effectiveness of secondary therapy and also contribute to adequate management of potentially aggressive PitNETs.

Aim. To conduct a meta-analysis of population-based observational studies of dapagliflozin compared with therapy without iNGLT-2 to assess its effect on the risk of cardiovascular events in patients with type 2 diabetes mellitus in real-world practice. Materials and methods. A systematic search was carried out in 3 bibliographic databases PubMed (Medline), Embase and eLibrary. According to the search results, 1,451 records were identified. 3 studies were selected for inclusion in the meta-analysis: CVD-REAL Nordic, EASEL Population-Based Cohort Study and CARDIA-MOS. The criteria for evaluating the effectiveness were the frequency of major adverse cardiovascular events (MACE) and cardiovascular mortality. The meta-analysis was carried out in the RevMan 5.4.1. Results. According to the results of the meta-analysis, there was a statistically significant association between the use of dapagliflozin and a decrease in the risk of MACE: relative risk 0.73, 95% confidence interval 0.650.82, as well as a decrease in cardiovascular mortality: relative risk 0.67, 95% confidence interval 0.480.92. Conclusion. Our results demonstrated that the use of dapagliflozin is associated with a reduction in the risk of developing MACE and cardiovascular mortality in patients with type 2 diabetes mellitus with cardiovascular diseases or cardiovascular risk factors.

Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is one of the most important medical and social problems associated with significant risks for patients and a burden on the national healthcare system. There are significant unmet diagnostic and therapeutic needs of CKD in T2D patients in Russia relating to problems of underdiagnostics of CKD and substantial residual cardiorenal risks in these patients in spite of therapy with registered renoprotective medications. Finerenone is the first selective non-steroidal mineralocorticoid receptor antagonist which targets different from other drugs pathways involved in the pathogenesis of CKD in T2D. It has a significant potential to reduce residual renal and CV risks, and therefore addresses the existing therapeutic unmet need. According to the results of recent clinical studies, the cardio- and renoprotective effects of finerenone were apparent throughout a wide range of CKD C1-C4 in T2D patients, regardless of the severity of kidney dysfunction, the level of HbA1c and other drug therapy. This document summarizes the main results regarding the efficacy and safety profiles of finerenone and determines its place in treatment of CKD in T2D patients.

The COVID-19 pandemic had a serious impact on global health and showed that the current state of most health systems in the world was not ready for such an emergency. During the pandemic, the provision of specialized planned medical care to patients with chronic diseases was suspended, and therefore telemedicine technologies for remote monitoring of patients began to be actively used in many countries of the world. In the Russian Federation, leading experts have issued organizational and methodological recommendations for the management of patients with diabetes and other chronic diseases during the COVID-19 pandemic. The measures taken by the government to provide medicines and prevent COVID-19 infection have allowed many patients with diabetes to observe a self-isolation regime. Meanwhile, there are data on the negative impact of self-isolation on the general condition of patients for various reasons: a decrease in the level of self-control and physical activity, a reduction in the volume of planned specialized medical care. Telemedicine technologies in the Russian Federation have been successfully used for remote monitoring of patients with mild and moderate severity of COVID-19. Currently, the widespread use of telemedicine and modern digital technologies, which proved their effectiveness during the pandemic in the treatment and control of diabetes, has not yet reached an optimal level. This review examines the possibilities of using telemedicine technologies for patients with diabetes, analyzes the experience of foreign countries and the Russian Federation in managing patients with diabetes during a pandemic, and analyzes the effectiveness of management measures to provide medical care to patients with diabetes.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Type 2 diabetes is characterized by increasing incidence and prevalence all-over the world. Current therapeutic management of type 2 diabetes is complex and is based not only on glycemic control, but also on cardiovascular and renal risks reduction. In previous years the use of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) increased in Russian Federation. Some manufacturers of the most widely used GLP-1 RA reported the supply decline in several countries. On Advisory board with participation of the Russian Endocrinology Association members the topics of SGLT2i and GLP-1 RA use in type 2 diabetes were discussed. The experts made conclusion that the decrease in access to GLP-1 RA does not pose serious risk for treatment of type 2 diabetes patients. SGLT2i show benefits in risk reduction of HF and CKD progression compering to GLP-1 RA, and in general show comparable efficacy in risk reduction of ACVD outcomes. SGLT2i show less glycemic efficacy in comparison with GLP-1 RA, and their replacement may need adding antidiabetic agents from other groups.