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

Интенсифицированная базисно-болюсная инсулинотерапия в режиме постоянной подкожной инфузии с помощью инсулиновой помпы (помповая инсулинотерапия) и непрерывное мониторирование гликемии высокотехнологичные лечебно-диагностические инструменты для ведения пациентов с сахарным диабетом, активно используемые во всем мире. Перевод на помповую инсулинотерапию и ведение пациентов, получающих данный вид лечения, а также проведение непрерывного мониторирования гликемии вошли в России в рутинную клиническую практику наравне с применением шприц-ручек и индивидуальных глюкометров. Настоящие клинические рекомендации основаны на международном и отечественном опыте применения помповой инсулинотерапии и непрерывного мониторирования гликемии в лечении сахарного диабета и призваны обеспечить единообразие подходов специалистов в процессе оказания медицинской помощи. Настоящая статья содержит предварительную версию клинических рекомендаций (проект), подготовленную к широкому обсуждению советом экспертов специалистов в области помповой инсулинотерапии. Итоговая версия клинических рекомендаций будет направлена на рассмотрение в Минздрав России с целью утверждения.

Цель. Определение частоты встречаемости аутоантител, характерных для аутоиммунных панкреатитов и гастритов у пациентов с сахарным диабетом 1 типа (СД1), особенности клинической картины у пациентов, положительных по данным параметрам. Материалы и методы. Обследовано 84 пациента (39 мужчин, 45 женщин) с СД1, которые были разделены на две группы. Проведено биохимическое, иммунологическое и инструментальное обследование. Результаты. Выявлена высокая частота встречаемости маркеров аутоиммунных заболеваний желудочно-кишечного тракта у пациентов с СД1, а также установлена высокая частота встречаемости исследуемых антител у пациентов с отсутствием клинической симптоматики, признаков поражения по данным инструментальных методов диагностики. Заключение. На основе полученных данных можно предположить, что пациенты с СД1 имеют более высокий риск возникновения сопутствующих аутоиммунных заболеваний с возможностью их бессимптомного течения.

Aim. to assess the occurrence of autoantibodies characteristic of autoimmune pancreatitis and gastritis in patients with type 1 diabetes mellitus (T1DM), and to analyze clinical features of positive subjects.Materials and Methods. 84 patients (39 male, 45 female) with T1DM were subdivided into two groups and underwent biochemical, immunologic and instrumental examination.Results. Markers for gastrointestinal autoimmune disorders were found to be highly prevalent in patients with T1DM, even in those asymptomatic according to instrumental diagnostic methods.Conclusion. Our data suggests that T1DM patients are at higher risk of corresponding, possibly asymptomatic autoimmune disorders.

Aim. To evaluate changes in functional activity and insulin resistance (IR) in patients with different types of onset of diabetes mellitus(DM). Materials and methods. We examined 166 subjects which were subdivided into 4 study groups and 1 control group. Assessment of totalbeta-cell functional activity and degree of IR (according to HOMA-model) was conducted in patients with different variants of DM onsetand in the group of high risk for type 1 DM. Results. The most significant decrease in beta-cell functional activity was found in patients with type 1 diabetes mellitus (HOMA-F 8.9%).Onset of LADA (Latent autoimmune diabetes in adults) and type 2 diabetes mellitus (T2DM) was also characterized by decreasein beta-cell functional activity (HOMA-F 39.2% and 63.9%, respectively), as well as by development of IR: HOMA-IR 3.7 and 7.2,respectively. Conclusion. Clinical onset of LADA and T2DM occurs against the background of decreased beta-cell functional activity and compromisedperipheral insulin sensitivity.

Precise dosing of insulin at meals and for correction of glycemia is crucial for sustention of optimal blood glucose concentration. Modern insulin delivery systems (such as insulin pumps) not only provide high dosing precision, but are also capable of calculating necessary dose by means of built- in software - so called "bolus calculators". However, patient- oriented approach to "calculator" settings, as well as their timely correction is imperative for attainment of desired precision. Though similar in their principle, various "calculators" also feature essential peculiarities that have to be considered for optimal adjustment. The review addresses current evidence for "bolus calculator" efficiency, comparative analysis of these applications and description of their key distinctions.

Aim. To evaluate changes in functional activity and insulin resistance (IR) in patients with different types of onset of diabetes mellitus (DM). Materials and methods. We examined 166 subjects which were subdivided into 4 study groups and 1 control group. Assessment of total ƒ-cell functional activity and degree of IR (according to HOMA-model) was conducted in patients with different variants of DM onset and in the group of high risk for type 1 DM. Results. The most significant decrease in ƒ-cell functional activity was found in patients with type 1 diabetes mellitus (HOMA-F 8.9%). Onset of LADA (Latent autoimmune diabetes in adults) and type 2 diabetes mellitus (T2DM) was also characterized by decrease in ƒ-cell functional activity (HOMA-F 39.2% and 63.9%, respectively), as well as by development of IR: HOMA-IR 3.7 and 7.2, respectively. Conclusion. Clinical onset of LADA and T2DM occurs against the background of decreased ƒ-cell functional activity and compromised peripheral insulin sensitivity.

Latent autoimmune diabetes of adults (LADA) is a variant of autoimmune diabetes mellitus. Its clinical feature not typical for classical DM1 despitethe presence of positive autoantibodies is characterized by the low rate of autoimmune destruction that accounts for the late development of insulindependence. Similar to classical DM1, LADA is associated with the loss of immune tolerance to autoantibodies. However, the quantitative andfunctional activity of Treg as key regulators of the immune response and main agents of immune tolerance remain as poorly known as their relationshipwith characteristics of apoptosis. Aim. To elucidate qualitative and functional changes at the level of immunity regulation in patients with LADA of different duration and theirrelationships with characteristics of apoptosis, immunological and genetic markers. Materials and methods. The study included 64 patients (45 men and 19 women) with LADA and 56 control subjects. The methods included HLAgenotyping, detection of autoantibodies against GAD, insulin, tyrosine phosphatase, islet cell antigens, composition of CD3+, CD4+, CD38+, HLADR+, CD25+, CD+25+, CD95, CD95L lymphocyte subpopulations, FoxP3 and C-peptide expression, HbA 1c levels. Results. FoxP3 expression at the onset of LADA was similar to that in control subjects while the relative amount of CD425+high T-lymphocytes increased.In contrast to DM1, FoxP3 expression began to decrease 6-12 months after the onset of LADA when the amount of CD425+high T-lymphocytes loweredto become normal with the progress of the disease. Within 1-5 years after the onset of LADA, FoxP3 expression became normal again but significantlyincreased when its duration exceeded 5 years. Expression of apoptosis markers (CD95 and CD95L) on lymphocytes and of their soluble forms in allLADA patients was comparable with control. Conclusion. We for the first time determined intensity of FoxP3 expression and the amount of CD425+high T-lymphocytes in patients with differentduration of LADA. FoxP3 expression varies periodically while functional deficit of Treg is delayed and appears to be compensated by a rise in theirnumber. Increased population of Treg within 6 months after the onset of LADA may reflect their regulatory role (suppression of autoimmunity)accounting for the gradual development of the disease.

Latent autoimmune diabetes of adults (LADA) is a variant of autoimmune diabetes mellitus. Its clinical feature not typical for classical DM1 despitethe presence of positive autoantibodies is characterized by the low rate of autoimmune destruction that accounts for the late development of insulindependence. Similar to classical DM1, LADA is associated with the loss of immune tolerance to autoantibodies. However, the quantitative andfunctional activity of Treg as key regulators of the immune response and main agents of immune tolerance remain as poorly known as their relationshipwith characteristics of apoptosis.Aim. To elucidate qualitative and functional changes at the level of immunity regulation in patients with LADA of different duration and theirrelationships with characteristics of apoptosis, immunological and genetic markers. Materials and methods. The study included 64 patients (45 men and 19 women) with LADA and 56 control subjects. The methods included HLAgenotyping, detection of autoantibodies against GAD, insulin, tyrosine phosphatase, islet cell antigens, composition of CD3+, CD4+, CD38+, HLADR+, CD25+, CD+25+, CD95, CD95L lymphocyte subpopulations, FoxP3 and C-peptide expression, HbA1c levels. Results. FoxP3 expression at the onset of LADA was similar to that in control subjects while the relative amount of CD425+high T-lymphocytes increased.In contrast to DM1, FoxP3 expression began to decrease 6-12 months after the onset of LADA when the amount of CD425+high T-lymphocytes loweredto become normal with the progress of the disease. Within 1-5 years after the onset of LADA, FoxP3 expression became normal again but significantlyincreased when its duration exceeded 5 years. Expression of apoptosis markers (CD95 and CD95L) on lymphocytes and of their soluble forms in allLADA patients was comparable with control. Conclusion. We for the first time determined intensity of FoxP3 expression and the amount of CD425+high T-lymphocytes in patients with differentduration of LADA. FoxP3 expression varies periodically while functional deficit of Treg is delayed and appears to be compensated by a rise in theirnumber. Increased population of Treg within 6 months after the onset of LADA may reflect their regulatory role (suppression of autoimmunity)accounting for the gradual development of the disease.