BACKGROUND : Binge eating disorder (BED) is the most prevalent eating disorder in the population, poorly studied in patients with Type 2 diabetes mellitus (T2DM). There are no generally accepted guidelines on pharmacological treatment of BED and no studies with more than 3-month duration. Glucagon-like peptide 1 receptor agonists (GLP1RA) could be a promising class of agents for the treatment of BED in T2DM patients due to their effects on central mechanisms of appetite and satiety regulation. AIM : To assess efficacy and safety of GLP1 RA for treatment of BED in patients with T2D. METHODS : Sixty six outpatients with T2DM and BED participated in this pilot open-label prospective comparative study of 6 mo’ duration followed by a 6 mo follow-up after GLP1RA withdrawal. All 66 continued their previous anti-hyperglycemic agents, 33 patients (50%) were prescribed a GLPRA (dulaglutide, or semaglutide, or lixisenatide combined with glargin). ­Thirty three patients were in the control group without GLPRA. In addition to standard clinical and laboratory examinations, all patients completed tests/questionnaires for assessment of their quality of life, depression, stait/trait anxiety, alexithymia and other personality characteristics, and physical complaints. Changes in BED severity and all other parameters were assessed at 3 and 6 months, and BED severity only was assessed at 6 months after the end of GLP1RA. RESULTS : After 6 months of GLP1RA therapy, 63,6% of the patients were in complete remission of BED (р<0,001), 36,3% were in partial remission, and complete form of BED was absent (0%). Along with BED improvement, there was a decrease of body weight from 106,3±17,6 to 98,9±17,2 kg at 6 months (р<0,00001), waist circumference from 118,1±12,5 to 110,1±12,0 cm (р<0,00001), and HbA1c levels by 1,2% from the baseline (р=0,0005). Improvement of BED was associated with positive changes of some psychological parameters, such as depression, hypochondriasis, general (but not diabetes-related) quality of life and psychosomatic complaints. In the control group, BED severity, anthropometric, metabolic, and psychological characteristics remained unchanged. At 6 months, most of the parameters studied in the GLP1RA group were significantly better than in the control. No patients withdrew from the study due to adverse events of GLP1 RA. At 6 months after GLP1RA withdrawal, BED relapsed in all patients. CONCLUSION : GLP1 receptor agonists are effective, safe and well tolerated in the treatment of BED in Type 2 diabetes patients. They facilitate the achievement of the main goal of BED treatment (complete or partial remission of BED) in 100% of the cases with marked improvements in metabolic and a range of psychological parameters.

Binge eating disorder (BED) is the most prevalent type of eating disorders encountered in endocrinological practice, with 5 to 66% of obesity patients seeking for losing weight, 10 to 25% of patients with Type 2 diabetes mellitus, and above 70% of Type 2 patients with morbid obesity having BED. BED can seriously challenge the treatment for Type 2 diabetes and obesity, but remains underdiagnosed and undertreated in most cases. The review discussed diagnostic criteria of BED and their evolution during the last three decades, as well as neurochemical, genetic, and psychological components of its pathophysiology and potential role of BED as a new risk factor for Type 2 diabetes. We have also analyzed medical treatments available for an endocrinologist, including potential use of agonists of glucagone-like peptide 1 receptors.

The article presents a case of a long-term mental disorder in a 35-year-old woman with a persistent laboratory-confirmed increase in cortisol levels, without clinical manifestations of hypercortisolism. The first signs of mental illness appeared at the age of 14; over the past 8 years, the disease has been continuous and manifests itself in the form of a predominantly depressive state with increasing severity and complication of symptoms. Throughout all the years of the disease, active psychopharmacotherapy was carried out, combinations of antidepressants with antipsychotics and mood stabilizers were used, but no pronounced effect was achieved. Inpatient treatment in the clinic of the Mental Health Research Center for 5 months using several methods of enhancing antidepressant therapy had a good therapeutic effect and made it possible to achieve complete remission of the disease. There was a normalization of laboratory parameters of cortisol along with a decrease in the severity of pathopsychological symptoms, which indicates the genesis of hypercortisolism secondary to mental illness and its functional nature. It is assumed that hypercortisolism in this patient contributed to the formation of atypical clinical symptoms and resistance to antidepressant therapy. The discussion substantiates the need to consult a psychiatrist in case of persistent hypercortisolism in the absence of clinical manifestations of Cushing's syndrome. The detection of persistent hypercortisolism in patients with depression determines the advisability of active therapy using several tactics to enhance the effect of antidepressants.

Background: hypothalamo-pituitary-adrenal (HPA) axis plays an important role in the pathogenesis of depression. Patterns of HPA functioning depend on both biologic factors and psychological background, which, taken together, may increase the risk of depression later on. Objective: to analyze scientific publications on pathophysiology of depression, linked to HPA disruption, assess causal relationship between hypercorticism and depression, role of hypercorticism in clinical symptoms and course of depressive disorder. Material and methods: according to the key words “hypercortiсism”, “depression disorder”, “cortisol”, “treatment resistant depression”, “Cushing’s syndrome”, “Сushing’s disease”, a search was conducted for publications in databases Medline/ PubMed, Scopus, Web of Science, RSCI and other resources. Conclusion: there is a high comorbidity between depressive disorders and HPA axis abnormalities, including endocrine disorders with both increased and decreased cortisol secretion. Hypercorticism related to Сushing’s disease or Cushing’s syndrome is often associated with irreversible mental disorders, especially anxiety and depressive disorders, which persist after normalization of cortisol levels. Depressive patients are characterized by persistently elevated cortisol levels and their non-supression in the 1 mg dexamethasone suppression test (DST); however, sometimes they have reduced cortisol secretion. The possible pathophysiology mechanisms of hypercorticism are discussed. Beside hypercorticism, increased level of adrenocorticotropic hormone (ACTH) and decreased secretion of ACTH after CRH stimulation are demonstrated. It has been demonstrated that elevation of cortisol levels may precede the development of depression and as such can be used as marker of increased depression risk. Hypercorticism in patients with depression may promote its increased severity and transform ation of depressive symptoms. Persistent hypercorticism and non-supression of cortisol in DST are predictors of poor outcomes. HPA dysfunction seems to play an essential role in evolvement of treatment resistant depression. There is data on the efficacy of drugs modifying HPA activity for amelioration of affective disorders and psychotic symptoms in patients with depression. Further research into HPA functioning in patients with depression are needed to clarify pathogenetic mechanisms and development of newer treatment approaches to depression.

Background. Subjective food perceptions in various aspects that could impact food choices and diet adherence by the Russian patients with type 2 diabetes mellitus (T2DM) have not been studied. Aim to assess food perceptions in T2DM patients in the reference group of dairy products and their potential influence on the nutritional structure. Aim: To assess food perceptions in T2DM patients in the reference group of dairy products and their potential influence on the nutritional structure. Materials and methods: This cross-sectional study included 300 consecutive out- and in-patients with T2DM (mean age standard deviation, 60,8 10,2 years, duration of diabetes 1 to 35 years). The patients underwent standard clinical and laboratory work-up and filled in the questionnaire on food perceptions of six dairy products (low fat cottage cheese, low fat milk, high fat milk, sour cream, cheese, and sweet cheese curds) in the following five aspects: impact on general health, impact on prevention of cardiovascular diseases, impact on glycemic control, taste and convenience of the use. These perception aspects were compared with the self-reported frequencies of the use of each product, patients demographic and clinical characteristics. Results: The patients considered low fat cottage cheese to be most healthy for their general health, with low fat milk and cheese ranking 2nd (р 0.0001 compared to low fat cottage cheese). Fat milk and sour cream were perceived as unhealthy (р 0.0001 compared to healthy products). Sweet cheese curds were perceived by the patients as the most unhealthy/harmful (р 0.0001 compared with each of the rest products). All other medical aspects of food perceptions (impact on cardiovascular prevention and diabetes control) moderately or strongly correlated between each other and with the perception for general health (Spearman's r from 0.42 to 0.72, all р 0.0001). Taste perceptions of all products, except sour cream, demonstrated moderate correlation with their perception in terms of convenience of the use (Spearman's r from 0.36 to 0.47, all р 0.0001). Male patients perceived low fat milk as more tasty and sour cream as more healthy, than female patients (р = 0.029 and 0.046, respectively). Female patients found sour cream more tasty (р = 0.019), and low fat cottage cheese and cheese as more healthy, than males (р = 0.009 and 0.014, respectively). The frequencies of the product use was associated with medical aspects of their perceptions: patients use to eat/drink low fat milk, low fat cottage cheese and cheese significantly more often, than high fat milk and sweet cheese curds (р 0.0001), whereas sour cream was in an intermediate position as per its frequency of the use. Low fat cottage cheese and cheese ranked first according to the proportion of their consumers (91.3 and 90.7% of the patients, respectively), low fat milk ranked second (82% of the patients), and sour cream third (75%), whereas most patients abstain from the use of fat milk and sweet cheese curds (32 and 32.3% using them, respectively). The frequency of the reference product use was to a significantly lesser extent associated with perceptions of their taste or convenience of the use and was not at all associated with their costs/prices. Conclusions: T2DM patients are able to clearly differentiate the products of the reference group (dairy products) for such aspects, as their impact on their general health, cardiovascular system and glycemic control. In most cases, these attitudes were not associated with their taste perceptions. It is exactly medical aspects of subjective food perceptions that have a higher impact on the nutritional structure (real-life use) than their taste or convenience of the use. This fact may become a favorable background for patient education in the area of rational nutrition and diet; however, patients knowledge on the food nutritional content and on their real impact on the health status need significant improvements. Methods. This cross-sectional study included 300 consecutive out- and in-patients with T2DM (mean age SD, 60,810,2 years, duration of diabetes 1 to 35 years). The patients underwent standard clinical and laboratory work-up and filled in the questionnaire on food perceptions of six dairy products (low fat cottage cheese, low fat milk, high fat milk, sour cream, cheese, and sweet cheese curds) in the following five aspects: impact on general health, impact on prevention of cardiovascular diseases, impact on glycemic control, taste and convenience of the use. These perception aspects were compared with the self-reported frequencies of the use of each product, patients demographic and clinical characteristics. Between-group comparisons were done with Students t-test, Mann-Whitney test (depending on the data distribution etc.), chi-square test, and ANOVA. Any associations between food perceptions and frequencies of the food use were assessed by Spearmans correlations. Results. The patients considered low fat cottage cheese to be most healthy for their general health, with low fat milk and cheese ranking 2nd (р 0.0001 compared to low fat cottage cheese). Fat milk and sour cream were perceived as unhealthy (р 0.0001 compared to healthy products). Sweet cheese curds were perceived by the patients as the most unhealthy/harmful (р0.0001 compared with each of the rest products). All other medical aspects of food perceptions (impact on cardiovascular prevention and diabetes control) moderately or strongly correlated between each other and with the perception for general health (Spearmans r from 0,42 to 0,72, all р 0.0001). Taste perceptions of all products, except sour cream, demonstrated moderate correlation with their perception in terms of convenience of the use (Spearmans r 0,36 to 0.47, all р 0.0001). Male patients perceived low fat milk as more tasty and sour cream as more healthy, than female patients (р = 0,029 and 0,046, respectively). Female patients found sour cream more tasty (р = 0,019), and low fat cottage cheese and cheese as more healthy, than males (р=0,009 and р = 0,014, respectively). The frequencies of the product use was associated with medical aspects of their perceptions: patients use to eat/drink low fat milk, low fat cottage cheese and cheese significantly more often, than high fat milk and sweet cheese curds (р0.0001), whereas sour cream was in an intermediate position as per its frequency of the use. Low fat cottage cheese and cheese ranked first according to the proportion of their consumers (91,3% and 90,7% of the patients, respectively), low fat milk ranked second (82% of the patients), and sour cream third (75%), whereas most patients abstain from the use of fat milk and sweet cheese curds (32% and 32,3% using them, respectively). The frequency of the reference product use was to a significantly lesser extent associated with perceptions of their taste or convenience of the use and was not at all associated with their costs/prices. Conclusions. T2DM patients are able to clearly differentiate the products of the reference group for such aspects, as their impact on their general health, cardiovascular system and glycemic control. In most cases, these attitudes were not associated with their taste perceptions. It is exactly medical aspects of subjective food perceptions that have a higher impact on the nutritional structure (real-life use) than their taste or convenience of the use. This fact may become a favorable background for patient education in the area of rational nutrition and diet; however, patients knowledge on the food nutritional content and on their real impact on the health status need significant improvements.

According to the decision of the WHO, therapeutic education (TE) of patients is an independent branch of medicine and an essential component of the treatment of chronic diseases, primarily diabetes mellitus and obesity. TE is implemented through the creation of “Schools for patients with diabetes mellitus” and “Schools for patients with overweight” (“Schools”) as a structural unit of a medical institution. On April 25–26, 2022, the First All-Russian Forum «Therapeutic Education in Endocrinology» was held online, organized by the Public Organization «Russian Association of Endocrinologists», which was attended by leading experts in this field. As a result of its work, this Resolution was adopted by the experts. It discusses the methodological and pedagogical foundations of TE, it is proposed to make changes related to the organization of the work of «Schools», tariffing in the obligatory health insurance system, and training of personnel, including nurses.

BACKGROUND: Psychological predictors of overall mortality in the Russian population of Type 2 diabetic patients and their impact compared to biological risk factors have not been studied.AIM. To identify clinical, laboratory and psychological factors independently associated with the 5-year overall mortality in Type 2 diabetic patients in the Moscow region.MATERIALS AND METHODS: This open label observational prospective study included 178 consecutive type 2 diabetic patients (women 145, men 33, age range 37 to 82 years, duration of diabetes 0,5 to 30 years). At baseline, in addition to the standard clinical, laboratory and instrumental work-up, all patients were assessed for depression, cognitive dysfunction and diabetes-related quality of life. No study-related intervention was performed; all patients were followed up and treated by their local physicians. After 5 years, we assessed the patients’ vital status (alive or dead). Multiple logistic regression was used to identify baseline patients’ characteristics, which were significantly and independently associated with 5-year overall mortality. Taking into account the exploratory type of multiple regression, the results were considered significant at α<0.1.RESULTS: At 5 years, 150 (84%) patients were alive and 15 (8,4%) were dead; no information could be obtained for the rest 13 (7,3%) patients. The analysis of 165 patients with the verified outcome, independent and significant associations with the death outcome were found for male gender (odds ratio [OR] 6,36 [95%CI 0,91–44.40]; p=0.06), age (OR 2.06 [1.30–3.27]; p<0.002), chronic heart failure (CHF) (OR 2.78 [1.25–6.2]; р=0.012), Hamilton depression scale score (OR 1,18 [1.03–1.34]; р=0.016), cognitive dysfunction score (Roschina scale) (OR 1.20 [1.05–1.35]; р=0.006), and age — body mass index interaction (OR 0,98 [0,97–0,997]; р = 0,013). The predicted probability of death within the next 5 years in men and women was 22,9% and 6,7%, respectively. The highest score of cognitive dysfunction was associated with a 25% predicted probability of death and the lowest, with a 2% probability of death; predicted probabilities of death for the highest and lowest depression scores were 26% and 2%, respectively. The 5-year predicted probability of death in the patients without CHF was 6,7%, with CHF I NYHA functional class, 9,8%, II functional class 13,6%, III functional class 18,2%, and IV functional class 23,5%. All other baseline clinical, laboratory, demographic, psychological and socioeconomic variables were not significantly associated with the 5-year survival rate. The model was not verified on an external cohort.CONCLUSION: Cognitive dysfunction and depression have a significant negative impact on the 5-year mortality rate at much higher degree, than glycemic control, any diabetes-related complications and cardiovascular disorders, excluding CHF. The results obtained highlight the importance of the diagnosis and treatment of depression and cognitive dysfunction in type 2 diabetes mellitus.

XXVIII) НАЦИОНАЛЬНЫЙ ДИАБЕТОЛОГИЧЕСКИЙ КОНГРЕСС С МЕЖДУНАРОДНЫМ УЧАСТИЕМ «САХАРНЫЙ ДИАБЕТ И ОЖИРЕНИЕ -НЕИНФЕКЦИОННЫЕ МЕЖДИСЦИПЛИНАРНЫЕ ПАНДЕМИИ XXI ВЕКА» СБОРНИК ТЕЗИСОВ

Dear Colleagues!We are glad to present the 10th Edition (revised) of the Standards of Specialized Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), European Association for the Study of Diabetes (EASD 2018, 2019), American Diabetes Association (ADA, 2018, 2019, 2021), American Association of Clinical Endocrinologists (AACE, 2020, 2021), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2018) and Russian Association of Endocrinologists (RAE, 2019). Current edition of the “Standards” also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, CREDENCE, CAROLINA, DAPA-CKD, DAPA-HF, EMPEROR-Reduced trial, VERIFY, VERTIS CV, PIONEER, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 537 million patients by the end of 2021. According to the current estimation by the International Diabetes Federation, 643 million patients will be suffering from DM by 2030 and 784 million by 2045.Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 871 863 patients with DM in this country on 01.01.2021 (3,34% of population) with 92,3% (4 498 826)–Type 2 DM, 5,6% (271 468)–Type 1 DM and 2,1% (101 569)–other types of DM, including 9 729 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) confirmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 10 million patients (about 7% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment and have high risk of vascular complications.Severe consequences of the global pandemic of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.In сurrent edition of the “Standards”:New goals of glycemic control for continuous glucose monitoring (time in range, below range and above range, glucose variability) are given.It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes.In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages.Indications for the use of antidiabetic agents in chronic kidney disease are expanded.Information about insulin pump therapy is added.Recommendations on vaccination are added.An algorithm for replacing some insulin preparations with others is given.This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discussions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians, pediatricians and other medical professionals involved in the treatment of DM.Compared with previous edition of the Standards of Specialized Diabetes Care edited by Dedov I.I., Shestakova M.V., ­Mayorov A.Yu., 10th edition, Moscow, 2021 (signed for printing on 10.09.2021) a number of changes have been made.On behalf of the Working Group

Background: The prevalence of obesity and metabolic abnormalities is increased patients with mental disorders receiving psychopharmacotherapy, which significantly impairs their treatment adherence. Aims: To evaluate the efficacy and safety of metformin in prevention and treatment obesity and overweight in patients with mental disorders receiving antipsychotics. Materials and methods : This was an open-label, prospective, randomized, placebo-controlled study of female patients with mental disorders (age, 18 to 50). The patients were randomized into two groups in a 2:1 ratio: the treatment group received metformin and the control group received placebo. Metformin was administered at a starting dose of 500 mg daily, with subsequent up-titration every 2 weeks when necessary, up to 2000 mg daily. The treatment duration was 6 months. Results: Baseline BMI in the treatment group (N=62) was 27,3 [24,0; 30,4] kg/m 2 ; it decreased to 26,0 [22,5; 30,5] kg/m 2 , p < 0.0001, Wilсoxon test) after 6 months of treatment. The patients receiving metformin decreased their body weight by 3 [-6; 0] kg, or -4,0 [-8; 0] %. In the placebo group (N=30), the baseline BMI was 27,5 [24,0; 32,0] kg/m 2 and increased to 28,2 [25,8; 34,0] kg/m 2 at 6 month (p=0.001, Wilсoxon test), or 3 [1; 6] kg. After 6 months of treatment, the difference in BMI between the metformin and placebo groups was significant (26,0 и 28,2 kg/m 2 , respectively, р=0,027, Mann-Withney test). Six (6) of 62 patients treated with metformin had side effects and were switched to an equivalent dose of prolonged release metformin, with reduction of side effects in 5 of them. Conclusions: The use of metformin in patients with mental disorders receiving antipsychotics allows for reduction or stabilization of body weight in 80% of cases, with ≥5% decrease of body weight in 44% of patients. It is recommended to start metformin at a dose of 500 mg daily with subsequent up-titration of up to 2000 mg if necessary.

OBJECTIVE:To assess the prevalence of mental disorders in patients with type 2 diabetes mellitus (DM2) and their relationship with laboratory findings, somatic comorbidities and psychosocial consequences.MATERIAL AND METHODS:In the frames of the INTERPRET-DD multicenter 200 T2DM patients from primary care (47 men and 153 women) from the Russian sample were studied. The psychometric assessment included MINI-6, HAMD-17, PHQ-9, PAID, WHO-5.RESULTS:One hundred and seventeen patients (58.5%) have mental disorders. Current mental disorders were diagnosed in 93 (46.5%) of patients. Depression (depressive episode, recurrent depressive disorder, bipolar affective disorder type II) was identified in 34 (17.0%), dysthymia in 26 (13.0%), and anxiety spectrum disorders in 39 (19.5%). In about half of the cases, anxiety disorders were combined with depression. The most severe problems were observed in the patients with depression and dysthymia. Patients with social phobia had significantly higher levels of glycated hemoglobin compared to patients without mental disorders. The significant decrease of systolic arterial pressure and body mass index was observed in patients with agoraphobia compared to patients without mental disorders. In addition, there was an increased prevalence of chronic ischemic heart disease in recurrent depression, dysthymia and generalized anxiety disorder, higher prevalence of neuropathy in depressive episode and recurrent depression and nephropathy in panic disorder.CONCLUSION:Depressive and anxiety disorders, as well as severe psychosocial problems, are consistently associated with T2DM. At the same time, concomitant somatic disorders and complications of DM2 are not just by chance comorbid to various forms of mental disorders, which allows for a new look at the problem of comorbidity/multimorbidity in T2DM.

Background: The prevalence of obesity and metabolic abnormalities is increased patients with mental disorders receiving psychopharmacotherapy, which significantly impairs their treatment adherence.Aims: To evaluate the efficacy and safety of metformin in prevention and treatment obesity and overweight in patients with mental disorders receiving antipsychotics.Materials and methods: This was an open-label, prospective, randomized, placebo-controlled study of female patients with mental disorders (age, 18 to 50). The patients were randomized into two groups in a 2:1 ratio: the treatment group received metformin and the control group received placebo. Metformin was administered at a starting dose of 500 mg daily, with subsequent up-titration every 2 weeks when necessary, up to 2000 mg daily. The treatment duration was 6 months.Results: Baseline BMI in the treatment group (N=62) was 27,3 [24,0; 30,4] kg/m2; it decreased to 26,0 [22,5; 30,5] kg/m2, p < 0.0001, Wilсoxon test) after 6 months of treatment. The patients receiving metformin decreased their body weight by 3 [-6; 0] kg, or -4,0 [-8; 0] %. In the placebo group (N=30), the baseline BMI was 27,5 [24,0; 32,0] kg/m2 and increased to 28,2 [25,8; 34,0] kg/m2 at 6 month (p=0.001, Wilсoxon test), or 3 [1; 6] kg. After 6 months of treatment, the difference in BMI between the metformin and placebo groups was significant (26,0 и 28,2 kg/m2, respectively, р=0,027, Mann-Withney test). Six (6) of 62 patients treated with metformin had side effects and were switched to an equivalent dose of prolonged release metformin, with reduction of side effects in 5 of them.Conclusions: The use of metformin in patients with mental disorders receiving antipsychotics allows for reduction or stabilization of body weight in 80% of cases, with ≥5% decrease of body weight in 44% of patients. It is recommended to start metformin at a dose of 500 mg daily with subsequent up-titration of up to 2000 mg if necessary.

Public organization “Russian Association of Endocrinologists”. Clinical guidlines.

Abstract Aims To examine the factors that are associated with changes in depression in people with type 2 diabetes living in 12 different countries. Methods People with type 2 diabetes treated in out-patient settings aged 18–65 years underwent a psychiatric assessment to diagnose major depressive disorder (MDD) at baseline and follow-up. At both time points, participants completed the Patient Health Questionnaire (PHQ-9), the WHO five-item Well-being scale (WHO-5) and the Problem Areas in Diabetes (PAID) scale which measures diabetes-related distress. A composite stress score (CSS) (the occurrence of stressful life events and their reported degree of ‘upset’) between baseline and follow-up was calculated. Demographic data and medical record information were collected. Separate regression analyses were conducted with MDD and PHQ-9 scores as the dependent variables. Results In total, there were 7.4% (120) incident cases of MDD with 81.5% (1317) continuing to remain free of a diagnosis of MDD. Univariate analyses demonstrated that those with MDD were more likely to be female, less likely to be physically active, more likely to have diabetes complications at baseline and have higher CSS. Mean scores for the WHO-5, PAID and PHQ-9 were poorer in those with incident MDD compared with those who had never had a diagnosis of MDD. Regression analyses demonstrated that higher PHQ-9, lower WHO-5 scores and greater CSS were significant predictors of incident MDD. Significant predictors of PHQ-9 were baseline PHQ-9 score, WHO-5, PAID and CSS. Conclusion This study demonstrates the importance of psychosocial factors in addition to physiological variables in the development of depressive symptoms and incident MDD in people with type 2 diabetes. Stressful life events, depressive symptoms and diabetes-related distress all play a significant role which has implications for practice. A more holistic approach to care, which recognises the interplay of these psychosocial factors, may help to mitigate their impact on diabetes self-management as well as MDD, thus early screening and treatment for symptoms is recommended.

Public organization “Russian Association of Endocrinologists”. Clinical guidelines.