Background. Patients with diabetes mellitus (DM) on renal replacement therapy (RRT) have high glycaemia variability (GV), the severity of which may depend on the dialysis method.The aim: To study GV in patients with type 1 diabetes and type 2 diabetes (on baseline-bolus insulin therapy) receiving RRT with programmed hemodialysis (PHD) and continuous ambulatory peritoneal dialysis (CAPD).Patients and Methods: Twenty-seven patients with terminal chronic renal failure and DM receiving RRT from July 2022 to March 2023 were studied. Patients underwent flash glucose monitoring (FGM) using FreeStyle Librе portable system with further evaluation of GV parameters and indices, median days of measurement – 14.Results. In the total group, 7 patients (23,3 %) had TIR > 70 %, mean TIR value was 56,3 %±22,0 %, 66,7 % of patients had CV > 36 %, mean CV value was 38,5 %±9,6 %. All indices of GV (MAGE, LBGI, HBGI, M-value, J-index, Conga, LI) exceeded the reference values. When comparing GV indices in patients on PHD and CAPD, it was revealed that LBGI in PHD group was 10,1±5,71 vs CAPD – 5,58±4,22, p=0,025. The critical point of glucose reduction on PHD was the fourth hour from the beginning of the procedure (57.1 % of patients had glycemia < 3.9 mmol/l). Higher median glucose values were found in the first three days of FGM compared to the last three days in both PHD group (p=0.002) and CAPD group (p=0.022).Conclusions. Patients with diabetes on RRT have high GV, low percentage of achieving TIR due to high risk of hypoglycemic conditions in patients on PHD. The critical point of glycaemia reduction is fourth hour after the start of the PHD session. Patients on CAPD have a lower risk of hypoglycemia. FGM improves glycaemic control.

Patients with type 2 diabetes mellitus (T2DM) are at high risk of adverse outcomes in coronavirus infection (COVID-19). Despite the gradual resolution of the pandemic, new strains of the virus are emerging, characterized by high contagiousness, and the risk of infection becoming a seasonal disease is increasing. In this connection, the issue of identifying risk factors that aggravate the course of COVID-19 in patients with T2DM, including the role of initial hypoglycemic therapy, remains relevant.The review presents and systematizes up-to-date information (according to randomized clinical trials and meta-analyses) on the effect of outpatient and inpatient use of metformin and innovative hypoglycemic drugs (glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, dipeptidyl peptidase-4 inhibitors) on the course and outcome of COVID-19 in patients with T2DM. At the same time, the potential mechanisms of the pathogenetic effect of drugs on the course of COVID-19, positive and negative aspects of their administration are described.

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.

Disorders in the kidneys lead to disturbance of homeostasis. As the glomerular filtration rate decreases, the metabolism of numerous biologically active substances, including pituitary hormones, decreases. The article presents an overview of pituitary dysfunction in patients with chronic kidney disease (CKD) and discusses the possible reasons of the pathogenetic mechanisms. Particular focus is being given to the assessment of changes in the concentration of pituitary hormones in patients with end-stage chronic kidney disease (CKD) and discusses the pathogenetic mechanisms of their formation. Particular attention is paid to the assessment of changes in the concentration of pituitary hormones in patients receiving renal replacement therapy (RRT). CKD leads to an increase in the level of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Concentrations of growth hormone (GH), isulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and vasopressin may remain within normal values or increase in this group of patients. RRT does not reduce the levels of prolactin, LH, FSH, while the concentration of growth hormone, IGF-1, TSH tends to normalize. The content of ACTH and vasopressin may remain unchanged or decrease. Kidney transplantation in most cases corrects hormonal disorders. Correction of hormonal changes can improve the clinical outcome and quality of life of patients with end stage CKD.

Amiodarone is an antiarrhythmic drug that is widely used in clinical practice to control various types of arrhythmias. One of the most significant side effects of amiodarone therapy is thyroid dysfunction, which is observed in about 15–20% of patients. This article presents a clinical case of a 55-year-old patient with a paroxysmal form of atrial fibrillation, for which amiodarone therapy was performed with the development of manifest amiodarone-induced thyrotoxicosis, refractory to drug therapy with glucocorticosteroids and thyrostatics. Due to the ineffectiveness of drug therapy, a total thyroidectomy was performed, which led to a rapid resolution of thyrotoxicosis and normalization of the heart rhythm.

ЦЕЛЬ: оценить влияние инициации терапии агонистами рецепторов глюкагоноподобного пептида 1 (арГПП-1) на клиническое течение коронавирусной инфекции (COVID-19) у госпитализированных пациентов с сахарным диабетом 2 типа (СД2). МАТЕРИАЛЫ И МЕТОДЫ: в исследование включены пациенты с СД2, индексом массы тела (ИМТ) > 27 кг/м2 и подтвержденной COVID-19. Основную группу составили пациенты, которым инициирована терапия дулаглутидом 1,5 мг 1 раз в неделю (n=53), группу контроля – больные, получавшие сахароснижающую терапию без арГПП-1 (n=50). Группы сопоставимы по возрасту, полу, стажу СД2, ИМТ, индексу коморбидности Чарслона, тяжести состояния и показателям провоспалительного статуса при поступлении, догоспитальной гипогликемической терапии, стартовой патогенетической и этиологической терапии. Оценивали исход COVID-19 (летальность/выживаемость), динамику клинических показателей (насыщение крови кислородом (метод пульсоксиметрии), необходимость кислородной поддержки, систолическое артериальное давление (САД), частота сердечных сокращений (ЧСС), частота дыхательных движений (ЧДД), оценка по шкале NEWS2 (National Early Warning Score) и степени поражения легочной ткани по данным компьютерной томографии (КТ). Обработка статистических данных проводилась с помощью программы IBM SPSS Statistics (26 версия), использовались непараметрические методы статистики. РЕЗУЛЬТАТЫ: лечение арГПП-1 снижало риск летального исхода в 3,5 раза по сравнению с группой контроля (5,7 vs 20,0%, р=0,038). Уровень насыщения крови кислородом на 7 день госпитализации был выше в основной группе (96% vs 93%, p=0,05). У пациентов, получающих дулаглутид, при внутригрупповом анализе в динамике отмечалось повышение сатурации с 95% до 96% (p=0,004); в группе контроля статистически достоверного изменения показателя в динамике не наблюдалось. В контрольной группе на 3 и 7 дни наблюдалась высокая частота необходимости кислородной поддержки по сравнению с основной группой, 3 день – 59,2% vs 37,7% (р=0,03), на 7 день – 60,4% vs 37,3% (р=0,021). Группы были сопоставимы на 1 и 7 дни по уровню САД, ЧСС и ЧДД: САД составляло 130 мм.рт.ст. в обеих группах на 1 день (р=0,86), на 7 день – 125 мм.рт.ст. в основной группе и 124 мм.рт.ст. в группе контроля (р=0,247), ЧСС на 1 день - 82 уд/мин в основной группе, 83 в группе контроля (р=0,434), на 7 день – 75 vs 73 уд/мин (р=0,533). ЧДД на 1 день - 18 движений в минуту в обеих группах (р=0,447), на 7 день – 18 vs 18 движений в минуту (р=0,357). На 7 день количество баллов по шкале NEWS2 в группе контроля было достоверно выше (3 балла), чем в основной группе (1 балл, р=0,021). По данным КТ на 7 день госпитализации в основной группе отмечалось ухудшение степени поражения у 21,2%, улучшение у 19,2% и отсутствие динамики у 59,6% пациентов, тогда как в группе контроля ухудшение выявлено у 42%, улучшение у 10%, отсутствие динамики у 48% процентов. Однако статистически значимых различий (анализ многопольной таблицы сопряженности) не выявлено (р=0,063). ВЫВОДЫ: инициация терапии арГПП-1 у пациентов с СД2, госпитализированных с COVID-19, благоприятно влияет на течение заболевания, снижая необходимость в оксигенотерапии, повышая уровень сатурации и снижая риск летального исхода.

ЦЕЛЬ: оценить потребность перевода на инсулинотерапию (ИТ) у госпитализированных больных са- харным диабетом 2 типа (СД2) и коронавирусной инфекцией. МАТЕРИАЛЫ И МЕТОДЫ: проведено ретроспективное сравнительное исследование госпитализиро- ванных в стационар пациентов с СД2 и ПЦР-подтвержденным диагнозом COVID-19 (n=86), не получавших ИТ до госпитализации. Выборка разделена на первую группу, в которой применялась патогенетическая терапия COVID-19 глюкокортикостероидами (ГКС) (n=56), и вторую – без ГКС (n=30). В группах исследования анализировались: глюкоза плазмы натощак (ГПН), получаемая сахароснижающая терапия в стационаре и при выписке, суточные дозы инсулина короткого действия (ИКД) и инсулина средней продолжитель- ности действия (инсулин НПХ). Обработка статистических данных проводилась с помощью программы IBM SPSS Statistics, 26 версия. РЕЗУЛЬТАТЫ: группы исследования сопоставимы по возрасту (n=0,768), полу (p=0,055), сопутствующей патологии: наличию гипертонической болезни (p=0,713), ишемической болезни сердца (p=0,561), хро- нической сердечной недостаточности (p=0,244), патологии органов дыхания (p=0,177), онкологическим заболеваниям (p=0,586), хронической болезни почек С3а и менее (p=0,771), ожирению (p=0,393), стажу диабета (p=0,896), а также по степени поражения легких по данным компьютерной томографии (КТ): КТ1 степени (p=0,983), КТ2 (p=0,050), КТ3 (p=0,549) и смертельным исходам (p=0,087). Также группы исследо- вания сопоставимы по уровню ГПН при поступлении (0,213). Пациенты, получавшие ГКС в 30,4% случаев, имели тяжелое течение COVID-19, в группе без ГКС все пациенты (100,0%) имели среднетяжелое течение (p<0,001). Также преобладало количество переведенных в отделение реанимации и интенсивной терапии в первой группе (21,4% против 0,0%, p=0,003). Применение ИТ в стационаре у пациентов, получавших ГКС, составило 87,5%, а в группе без ГКС – 46,7% (p<0,001), ИКД получали 73,2% больных в первой группе против 43,3% во второй (p=0,001), инсулин НПХ – 55,4% против 6,7%, p<0,001, соответственно. Отмечалась более высокая потребность в суточных дозах ИКД при поступлении (20 ЕД против 7 ЕД, p=0,001), на третьи (23 ЕД против 8 ЕД, p<0,001) и седьмые сутки (24 ЕД против 4 ЕД, p<0,001) в группе ГКС, тогда как по суточным дозам инсулина НПХ при поступлении (p=0,333), на третьи (p=0,159) и седьмые сутки (p=0,462) группы не различались. Медиана ГПН на третьи сутки госпитализации выше в первой группе (10,6 против 7,0 ммоль/л, p<0,001). По уровню ГПН на седьмые сутки (p=0,524) группы не имели различий. В первой группе 5,4% пациентов рекомендованы ГКС при выписке, во второй – 0,0% (p=0,003). Однако, потребность в инсулинотерапии при выписке имели 21,4% пациентов в первой и 3,3% во второй группах (p=0,026), без достоверных различий по доле применения ИКД (p=0,070) и базального инсулина (p=1,0). ВЫВОДЫ: гипергликемия при коронавирусной инфекции у больных с СД2, не получавших инсулин до госпитализации, способствует переводу на ИТ в стационаре в 46,7% случаев даже у пациентов, не полу- чающих ГКС. При применении ГКС у пациентов с СД2 в лечении COVID-19 отмечается большая потребность как в ИКД (73,2%), так и в инсулине НПХ (55,4%). После применения ГКС сохраняется высокая доля больных СД2, нуждающихся в ИТ при выписке.

BACKGROUND. The search for new effective methods of treatment and prevention of COVID-19 in patients with type 2 diabetes mellitus (T2DM) remains an urgent task for the healthcare system.AIM. To evaluate the efficacy and safety of initiating of glucagon-like peptide-1 receptor agonists (GLP-1RA) therapy in T2DM patients hospitalized with COVID-19.MATERIALS AND METHODS. The inclusion criteria were history of T2DM, BMI> 27 kg/m2, confirmed diagnosis of COVID-19. The intervention group of 53 patients started dulaglutide therapy (1,5 mg once weekly) during the first 24 hours of admission, the control group consisted of 50 patients, who proceeded with glucose-lowering therapy. We evaluated the effect of therapy on carbohydrate metabolism, laboratory and clinical parameters, the outcome of COVID-19 and the safety of therapy (hypoglycemic events, side effects).RESULTS. There were no differences found in the degree of decrease in the level of glycemia in the compared groups: fasting plasma glucose (FPG) on day 7 of hospitalization– 8,2 [6,0;9,8] mmol/L vs 8,1 [6,5;9,8] mmol/L (p=0,935), mean daily glycemia (MDG) — 9,7 [8,3;11,8] mmol/L vs 11,1 [8,7;12,8] mmol/L (p=0,182). Therapy of dulaglutide had a positive effect on inflammatory markers: CRP (15,8 vs 24,4 mg/l, p=0,035), LDH (261,6 vs 326,1 U/l, p=0,016) and the level of lymphocytes (1,2 vs 0,9 x 10*9/L, p=0,049) and on clinical parameters: saturation, the need for oxygen therapy and the risk of severe course according to the NEWS2 scale. The death rate in the group receiving GLP-1RA is 3,5 times lower compared to the control group (5,7% vs 20,0%, p=0,038). The initiation of dulaglutide therapy in patients with T2DM hospitalized with COVID-19 reduced the chance of death and transfer to mechanical ventilation by 4,2 times compared to the control group (OR = 0,24, 95% CI: 0,062–0,931). GLP-1RA therapy in patients with COVID-19 and T2DM is safe in terms of hypoglycemic events and side effects.CONCLUSIONS. The initiation of GLP-1RA therapy leads to a decrease in FPG and MDG, comparable with the control group. The start of GLP-1RA therapy in hospitalized patients with COVID-19 and T2DM reduces the chance of death, favorably affecting on laboratory and clinical parameters.

Background: patients with Diabetes Mellitus 2 (DM2) and advanced stages of Diabetic Kidney Disease (DKD) are at high risk for the lethal outcome of COVID-19. The causes of high mortality and the prognostic signifi cance of the new onset of renal replacement therapy (hemodialysis de novo, HD de novo) among these patients are still points of debate. Aim: the identifi cation of risk factors (RF) of lethal outcome in patients with DKD 4-5D stages and evaluation of the prognostic value of HD de novo in patients not receiving HD at the time of hospital admission. Methods: the patients with COVID-19 and advanced stages of DKD were included in a retrospective observational study from 04.01. to 10.30.2020. The endpoints were the outcome of hospitalization (discharge/death) and HD de novo initiation during the inpatient course. Several demographic, DM2, DKD, and COVID-19-associated signs and laboratory parameters were analyzed as independent variables. The subgroup of patients with HD de novo was selected from the general cohort. Results: 120 patients with DKD 4-5D stages were included, with a mean age of 69±10 y, females - 52%. Initially, the observation cohort was divided into subgroups: DKD 4-5 and DKD 5D on maintenance hemodialysis (MHD). The mortality among patients with DKD 4-5 was comparable with the patients on MHD (38,2% vs 38,5%, р=0,975). The independent predictors of lethal outcome in group DKD 4-5 were: age ≥65 y (OR 12,30;95% CI 1,40-33,5;р=0,009), initial prandial glycemia ≥10 mmol/l (OR 14,5;95% CI 3,7-55,4;р<0,001), albuminemia at admission ≤35 g/l (OR 5,17;95% CI 1,52-17,50;р=0,012), Charlson comorbidity index (CCI) ≥10 (OR 6,69;95% CI 1,95-23,00;р=0,002), News2 >4 at admission (OR 7,58;95% CI 2,18-26,37;р=0,001), lung damage CT 3-4 at admission (OR 3,39;95% CI 1,09-10,58;р=0,031). In subgroup DKD 5D the independent predictors of lethal outcome were prandial glycemia at admission ≥10 mmol/l (OR 28,5;95% CI 7,1-33,5;р<0,001), lung damage at admission CT 3-4 (OR 8,35;95% CI 2,64-26,40;р<0,001), CCI ≥10 (OR 6,00;95% CI 1,62-22,16;р=0,006). To determine the risk of lethal outcome predictive models were created using identifi ed risk factors and variables. The predictive value for DKD 4-5 group was 93%, and for DKD 5D was 88%. The assessment of the overall predictive value of these models was carried out using ROC analysis. The mortality among patients with DKD 4-5 without HD de novo was 21,6% vs 72,2% in patients with initiated HD de novo (р<0,001). The independent predictors of HD de novo during the inpatient course were: prandial glycemia at admission ≥10 mmol/l (OR 3,38;95% CI 1,04-10,98;р=0,050), albuminemia at admission ≤35 г/л (OR 3,41;95% CI 1,00-11,55;р=0,050), News2 >4 at admission (OR 5,60;95% CI 1,67-19,47;р=0,006), eGFR ≤20 ml/min/1,73 m2 at admission (OR 4,24;95% CI 1,29-13,99;р=0,020). HD de novo was identifi ed as an independent predictor of adverse outcomes (OR 9,42;95% CI 2,58-34,4;р=0,001). The analysis of cumulative survival demonstrated comparable results in DKD 4-5 without HD de novo group and DKD 5D group. The cumulative 55-day survival in the subgroup with HD de novo was only 10%. Conclusion: the need to start HD de novo is one of the most powerful predictors of adverse outcomes of COVID-19 in patients with advanced DKD. The comparable mortality rate in DKD 4-5 and DKD 5D groups is due to extremely high mortality in the subgroup with HD de novo. The strict control and correction of HD de novo risk factors could turn them into modifi able ones and thus improve the survival prognosis of patients with advanced stages of DKD. © 2023 JSC Vidal Rus. All rights reserved.

BACKGROUND. Patients with Diabetes Mellitus 2 (DM2) and Chronic Kidney Disease (CKD) are at a high risk for severe clinical course of COVID-19. The high mortality rate due to COVID-19 and widespread distribution of DM2 and CKD all over the world make it necessary to determine the predictors of adverse outcome of novel coronavirus infection (NCI). AIM. The identification of predictors of NCI adverse outcome in patients with DM2 and CKD stage 3 due to diabetic kidney disease. Patients and Methods . The patients with NCI and CKD stage 3 were included in observational retrospective uncontrolled study during the follow-up period from 04.01. to 10.30.2020. The study endpoints were the outcome of NCI (survivors/nonsurvivors). Data were collected from electronic versions of case records. Demographic, DM2-related, CKD-related and NCI-related baseline parameters/signs were studied as independent variables. RESULTS. 90 patients with DM2 and CKD stages 3 (Me GFR 43[37; 49] ml/ min/1,73m 2 ) were included, mean age 70 [69; 78] y, females – 56 %, the mortality rate – 21 %. The independent predictors of NCI adverse outcome were detected using a single factor analysis (odds ratio). Among them are: initial prandial glycemia ≥ 10 mmol/l (ОR 11,8; 95 % CI 3,13–44,9; р <0,001), albuminemia at admission ≤ 35 g/l (ОR 5,52; 95 % CI 1,85–16,55; р = 0,012), initial proteinuria ≥ 1 g/л (ОR 6,69; 95 % CI 1,95–23,00; р = 0,002), News2 ≥ 5 at admission (ОR 14,7; 95 % CI 3,15–48,8; р <0,001), lung damage CT 3–4 at admission (ОR 31,7; 95 % CI 6,59–52,85; р = 0,04). A prognostic model was constructed to determine the risk of lethal outcome using logistic regression method. The detected risk factors were used as variables. The predictive value of the model was 93 % according to ROC-analyses data. CONCLUSION . The detected predictors of adverse outcome are the part of routine screening available in pre-hospital setting and at hospital admission. Early identification of predictors allows optimizing patient routing and selecting the best treatment strategy for each patient.

Background: Obesity is recognized as a risk factor for adverse outcomes in patients with COVID-19. However, a number of studies, including an analysis of the Federal Registry of Diabetic Patients (Russian Federation), have not identified any significant effect of obesity on mortality in COVID-19. Therefore, the role of obesity, assessed by body mass index (BMI) and waist circumference (WC), as a risk factor for an unfavorable course of coronavirus infection remains disputable. Aim: To assess the impact of obesity on the severity and outcomes of coronavirus infection in the Russian population of hospitalized patients. Materials and methods: This was a single center, retrospective, observational study in 367 patients with the polymerase chain reaction (PCR)-confirmed diagnosis of COVID-19 hospitalized to the in-patient department from April 2020 to November 2021. The first group included 185 patients with obesity (BMI 30.0 kg/m2); the second group consisted of 182 patients without obesity (BMI 30.0 kg/m2). Prevalence of comorbidities, clinical and laboratory parameters, and computed tomography results were assessed in both groups. WC was measured in 100 patients. Results: In this Russian population of hospitalized patients with COVID-19, obesity (BMI 30.0 kg/m2) didn't increase the probability of death both in the general sample (odds ratio (OR) = 1.31; 95% confidence interval (CI) 0.901.92, p = 0.164) and in the patients with type 2 diabetes (OR = 1.0; 95% CI 0.591.7, p = 0.997) or without diabetes (OR = 1.3; 95% CI 0.712.39, p = 0.392). However, obesity was associated with a 1,7-fold increase of the risk of severe COVID-19 (95% CI 1.132.59, p = 0.010). Morbid and abdominal obesity (according to World Health Organization and International Diabetes Federation criteria) had no significant impact on the death rate. WC of 101 cm, regardless of the patients gender, was associated with a 4,9-fold increase of the risk of death (95% CI 1.4516.42, p = 0.012). Conclusion: Obesity didnt show any significant effect on mortality, but increased the chance of severe course of COVID-19 infection. Abdominal obesity (WC 101 cm) was a more significant factor in predicting of a fatal outcome, than BMI.

ЦЕЛЬ: оценить влияние инициации терапии агонистами рецепторов глюкагоноподобного пептида 1 (арГПП-1) на клиническое течение коронавирусной инфекции (COVID-19) у госпитализированных пациентов с сахарным диабетом 2 типа (СД2). МАТЕРИАЛЫ И МЕТОДЫ: в исследование включены пациенты с СД2, индексом массы тела (ИМТ) > 27 кг/м2 и подтвержденной COVID-19. Основную группу составили пациенты, которым инициирована терапия дулаглутидом 1,5 мг 1 раз в неделю (n=53), группу контроля – больные, получавшие сахароснижающую терапию без арГПП-1 (n=50). Группы сопоставимы по возрасту, полу, стажу СД2, ИМТ, индексу коморбидности Чарслона, тяжести состояния и показателям провоспалительного статуса при поступлении, догоспитальной гипогликемической терапии, стартовой патогенетической и этиологической терапии. Оценивали исход COVID-19 (летальность/выживаемость), динамику клинических показателей (насыщение крови кислородом (метод пульсоксиметрии), необходимость кислородной поддержки, систолическое артериальное давление (САД), частота сердечных сокращений (ЧСС), частота дыхательных движений (ЧДД), оценка по шкале NEWS2 (National Early Warning Score) и степени поражения легочной ткани по данным компьютерной томографии (КТ). Обработка статистических данных проводилась с помощью программы IBM SPSS Statistics (26 версия), использовались непараметрические методы статистики. РЕЗУЛЬТАТЫ: лечение арГПП-1 снижало риск летального исхода в 3,5 раза по сравнению с группой контроля (5,7 vs 20,0%, р=0,038). Уровень насыщения крови кислородом на 7 день госпитализации был выше в основной группе (96% vs 93%, p=0,05). У пациентов, получающих дулаглутид, при внутригрупповом анализе в динамике отмечалось повышение сатурации с 95% до 96% (p=0,004); в группе контроля статистически достоверного изменения показателя в динамике не наблюдалось. В контрольной группе на 3 и 7 дни наблюдалась высокая частота необходимости кислородной поддержки по сравнению с основной группой, 3 день – 59,2% vs 37,7% (р=0,03), на 7 день – 60,4% vs 37,3% (р=0,021). Группы были сопоставимы на 1 и 7 дни по уровню САД, ЧСС и ЧДД: САД составляло 130 мм.рт.ст. в обеих группах на 1 день (р=0,86), на 7 день – 125 мм.рт.ст. в основной группе и 124 мм.рт.ст. в группе контроля (р=0,247), ЧСС на 1 день - 82 уд/мин в основной группе, 83 в группе контроля (р=0,434), на 7 день – 75 vs 73 уд/мин (р=0,533). ЧДД на 1 день - 18 движений в минуту в обеих группах (р=0,447), на 7 день – 18 vs 18 движений в минуту (р=0,357). На 7 день количество баллов по шкале NEWS2 в группе контроля было достоверно выше (3 балла), чем в основной группе (1 балл, р=0,021). По данным КТ на 7 день госпитализации в основной группе отмечалось ухудшение степени поражения у 21,2%, улучшение у 19,2% и отсутствие динамики у 59,6% пациентов, тогда как в группе контроля ухудшение выявлено у 42%, улучшение у 10%, отсутствие динамики у 48% процентов. Однако статистически значимых различий (анализ многопольной таблицы сопряженности) не выявлено (р=0,063). ВЫВОДЫ: инициация терапии арГПП-1 у пациентов с СД2, госпитализированных с COVID-19, благоприятно влияет на течение заболевания, снижая необходимость в оксигенотерапии, повышая уровень сатурации и снижая риск летального исхода.

Patients with type 1 Diabetes Mellitus (T1DM) on renal replacement therapy with maintenance hemodialysis (MHD) are prone to develop hypoglycemia, as well as high glycemic variability on both dialysis and non-dialysis days. Reliability of glycated hemoglobin in dialysis patients with DM as a marker of carbohydrate metabolism compensation is reduced due to the influence of anemia, uremia, mechanical damage of erythrocytes during diffusion through the dialyzing membrane. Continuous glucose monitoring (CGM) is one of the methods for monitoring and correction glycemic variability in dialysis patients with DM. This article presents a description of a clinical case of the patient with T1DM on MHD receiving insulin therapy using an insulin pump in combination with CGM (FreeStyle Libre portable system) and highlights the difficulties of correcting insulin therapy on dialysis and non-dialysis days. The discussion section presents the JBDS-IP 2022 (UK) recommendations for the correction of insulin therapy in patients with DM on dialysis (it is recommended to reduce the insulin dose by 25% on dialysis days, immediately after the start of the HD procedure). Particular attention is focused on the need for a personalized approach to the correction of insulin therapy in dialysis patients with DM due to the comorbidity of this group of patients and the difficulties in extrapolating recommendations into real clinical practice.

The problem of the impact of coronavirus infection on carbohydrate metabolism remains open. In the course of the disease, various disorders of carbohydrate metabolism are detected, including newly diagnosed diabetes mellitus and transient hyperglycemia. This article presents two clinical cases with different course and duration of transient stress hyperglycemia against the background of coronavirus infection.

Журнал для непрерывного медицинского образования врачей эволюция распространенности кардиоренального континуума у госпитализированных пациентов с сахарным диабетом 2 типа в

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.