Lesions of the lower extremities in diabetes mellitus are a complex and urgent problem of modern medicine. The high prevalence of diabetes mellitus, significant difficulties in timely diagnosis, differential diagnosis and the choice of therapeutic tactics to preserve the supporting function of the limb determine the difficulties in managing diabetic patients. Over the past decades, significant changes have occurred in the structure of specialized medical care for diabetic foot patients which has significantly reduced the number of high amputations, improved the quality and life expectancy of patients. The article presents the results of the long-term experience of the Diabetic Foot department in the treatment of diabetic foot patients.

BACKGROUND: Diabetes mellitus (DM) is a dangerous challenge to society and high-priority goals for health systems worldwide due to the severity of diabetic complications leading to disability and premature mortality in this category of patients. AIM: To carry out an analysis of epidemiological, clinical and therapeutic characteristics of DM control in the Russian Federation (RF) according to the strategy goals of the World Health Organization (WHO) by 2030 (diagnosis of DM; control of glycemia, blood pressure in DM patients; assignment of statins to DM patients; ensuring the availability of insulin and means for self-monitoring of the level of glycemia) based on the << Database of clinical and epidemiological monitoring of DM in the territory of the Russian Federation (RF)>>. MATERIALS AND METHODS. The research performed on the basis of the de-personalized "Database of clinical and epidemiological monitoring of DM in the territory of the RF", certificate of state registration database N degrees 2020622447 (http://diaregistry.ru, register of DM), which included 87 regions of the RF. Data are presented as cross-sectional study in 01.07.2024. RESULTS: According to the Database of clinical and epidemiological monitoring of DM in the territory of the RF, the target HbA(1c)<7% is achieved in 29% of patients with type 1 DM (T1DM) and 42% of patients with T2DM. Effective blood pressure control in people with diagnosed DM is achieved in 84% of patients with T1DM and 60% of patients with T2DM. The proportion of patients receiving statins aged 40 and over is 14.1% for T1DM, 15.9% for T2DM. All patients with T1DM (100%) and T2DM on insulin therapy are provided with insulin under the program of state guarantee of drug provision, of them insulin analogues in T1DM - 84,8%, in T2DM - 60,9%, the rest - recombinant human insulins. Self-monitoring devices (glucometers and test strips for them) are provided to 100% of patients with DM. Since 2023, patients with T1DM under 18 years old are provided by continuous glucose monitoring systems. CONCLUSION: Common diabetes monitoring system based on "Database of clinical and epidemiological monitoring of DM in the territory of the RF" at the national level allows to assess the effectiveness of programs to achieve the WHO targets. The data analysis identifies priority areas for the most effective and achievable interventions to strengthen and monitor diabetes control. Providing timely, reliable and sustainable national information on risk factors, epidemiology and clinical data of DM, access to medical drugs and modern technologies of control requires coordinated work by health professionals.

Chronic kidney disease (CKD) is a supranosological concept, defined as a disorder of the structure and/or function of the kidneys for 3 months or more that leads to health consequences. CKD develops in 20–40% of patients with diabetes mellitus (DM). Dynamic analysis of epidemiological indicators of CKD in patients with diabetes mellitus points to the prevalence increase of this pathology in the Russian Federation in 2010–2022. Improved quality of diagnostics of earlier stages complications, a decrease in the risk of cardiovascular events (the leading cause of death) and end-stage renal failure at a later age and with a longer duration of diabetes are noted as well. The development of tools for predicting the risk of the pathology progression and its complications has made it possible to improve patient monitoring and routing. Current international and domestic recommendations emphasize a comprehensive approach to the treatment of CKD, including lifestyle modification, evidence-based pharmacological treatments aimed at preserving organ function, and improving cardiovascular prognosis. An optimal model of care for patients with diabetes and CKD, aimed at multidisciplinary care and adapted according to the severity of CKD, will lead to the best outcomes for the individual patient and society.

BACKGROUND: Diabetic retinal involvements as proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME), revealed in most cases of PDR, are main causes of best corrected visual acuity (BCVA) loss in diabetic patients. PDR represents late diabetes mellitus (DM) complication, in severe cases it requires vitreoretinal surgery (VRS). Given high risk of vision loss and comorbidity of PDR patients, optimal choice of ophthalmological treatment strategy is still actual. AIM: to compare clinical guides' recommendations accomplishment and real clinical practice, analyze main retinal diabetic involvement diagnosis and management problems, on diabetic patients, presented to Endocrinology Research Center of the Ministry of Health of the Russian Federation for VRS. MATERIALS AND METHODS: Study subjects: data of medical records and endocards (Endocrinology Research Center diabetic patients clinical statistical registration cards) of 252 patients (260 eyes) with type 1 (n=168) and type 2 (n=84) DM, undergoing VRS from 2019 to 2023. We analyzed reasons for PDR deterioration, VRS results, frequencies of cardiovascular (CV) and diabetic complications, that heighten risks of cardiovascular events (CVE), such as atherosclerotic diseases, ischemic heart disease (IHD), chronic heart failure (CHF), cerebrovascular accident (CVA), chronic kidney disease (CKD), and diabetic foot syndrome (DFS). Inclusion criterion was presence of PDR complication, requiring VRS, irrespective of its severity. Standard ophthalmological investigation, ultrasound B-scan of the eyes, retinal optical coherent tomography (OCT), and fundus photography were carried out. BCVA evaluation was made before VRS and one month after the procedure. Proliferative process stabilization was checked up in one month to five years. RESULTS: Median age of patients with T1DM/T2DM was 39/63 years, DM duration before VRS was 19/17 years, females constituted 63%/57% of patients, respectively. In 258 eyes of 260 (99,2%) retinal photocoagulation (PC) before VRS procedure was not accomplished or was not performed at all. In all patients one month after procedure BCVA grew higher, but it strictly depended on baseline BCVA, which was determined by PDR complication severity. Before/afterVRS in 76 eyes (29%) it constituted between light perception with projection and 0,05/0,01-0,08; in 68 eyes (26%) - 0,06-0,1/0,08-0,3; in 62 eyes (24%) - 0,2-0,3/0,3-0,5; in 54 eyes (21%) - 0,4-0,8/0,5-1,0 in decimals, respectively. Concurrent conditions frequencies among DM1/DM2 patients were for atherosclerosis - 47%/67%, for IHD - 9%/32%, for CVA - 4%/9%, for CHF - 5%/30%, for CKD - 71%/63% (including CKD stage C5 24,7%/13,6%), for DFS - 29%/17%, for amputations - 13%/17% of cases, respectively. CONCLUSION: In the studied cohort of patients with severe PDR, frequent concurrent conditions and high CVE risks in 99,2% of cases retinal PC extent was improper, that lead to complications and need for VRS. In patients with PDR and comorbidities panretinal PC should be carried out without delay, as it is required by clinical guidelines.To avoid severe visual loss panretinal PC must be the treatment of high priority.

Therapeutic education for patients with diabetes mellitus (DM) has become an important and mandatory component the comprehensive management of this disease. This approach integrates several disciplines such as medicine, pedagogy and psychology, making it a unique field aimed at improving the health and quality of life of patients. The goal of therapeutic education is not only to provide information about the disease, but also to teach the patient self-management skills, proper nutrition, self-adjustment of insulin doses, and recognizing the signs of possible complications. Effective management of DM is impossible without the patient's participation. Continuous monitoring of glucose levels, timely adjustments of insulin doses and compliance with dietary recommendations require the patient's informed and active participation in the treatment process. Therapeutic education helps patients to better understand their condition, recognize the importance of self-management and improve their disease management skills. Thus, education becomes an integral part of treatment, ensuring the achievement of long-term goals for maintaining optimal glycemia levels and preventing the development or progression of complications. Since the end of the 20th century, Russia began to develop its own school of therapeutic education for patients with diabetes mellitus. Various programs were created, including courses for patients and their relatives, seminars with doctors. These programs have proven to be effective in the long term, as evidenced by the improvement of carbohydrate metabolism compensation indicators in patients with diabetes, as well as a reduction in the frequency of hospitalizations and complications. Thus, therapeutic education within the framework of comprehensive diabetes treatment not only contributes to the improvement of individual health indicators of patients, but also has a positive impact on the overall efficiency of the health care system.

ОПЫТ ПРИМЕНЕНИЯ ИНФОРМАЦИОННО-КОММУНИКАЦИОННЫХ ТЕХНОЛОГИЙ НА КАФЕДРЕ МЕДИЦИНСКОЙ И БИОЛОГИЧЕСКОЙ ФИЗИКИ СГМУ (Г. АРХАНГЕЛЬСК)Тарасова А.В. 1 , Малыгина О.Г. 1 , Шестакова М.В

BACKGROUND: Population aging leads to an increase in the prevalence of age-associated diseases, which makes it relevant to study the characteristics of diabetes mellitus (DM) in older adults. AIM: The aim of our study was to analyze the clinical and epidemiological characteristics of DM in elderly people (≥65 years), the state of carbohydrate metabolism (level of HbA 1c ), the frequency of diabetic complications and the characteristics of glucose-lowering therapy (GLT) in the Russian Federation (RF). MATERIALS AND METHODS: Object of the study: Russian cohort of patients with diabetes based on the diabetes registry (http://diaregistry.ru), a depersonalized data unloading as of 01.01.2024, including patients from 87 regions of the RF, n=5205647. Patients were stratified by age ≥ and <65 years into 2 groups: “65+”, n=3085805 and “65-”, n=2119842 and analyzed in the subgroups of type 1 and type 2 DM, in dynamics 2013–2023. RESULTS: The total number of DM patients aged 65+ is 3085805, which is 59,3% of the total number of DM patients; with type 2 diabetes (T2DM) — 63,8%, with type 1 diabetes (T1DM) — 8,1% of patients. Over the period 2013-2023, there was an ­increase in the proportion of elderly people with T2DM from 50,2% to 63,8%, with T1DM — 7,9-8,1%. The proportion of patients with onset of T2DM over the age 60 years increased from 51% to 63%. Clinical characteristics in the «65+» and «65-» group differed significantly in T1DM in the level of HbA 1c 7,8 vs 8,0%, level of GFR 75,0 vs 107,2 ml/min/1,73 m 2 , BMI 26,9 vs 23,2 kg/m 2 ; in T2DM the level of HbA 1c 7,3 vs 7,5%, level of GFR 73,1 vs 89,1 ml/min/1,73 m 2 ; BMI 30,9 vs 32,0 kg/m 2 , respectively. The proportion of obese patients increased with age in T1DM from 13% to 36%, and decreased in T2DM from 62% to 54%. In the group of older patients with both types of DM, a higher frequency of diabetic complications with combined damage to target organs of CKD, ASCVD and CHF was observed: on average 4,6 times with in T1DM, 2,2 times in T2DM. When analyzing the GLT in the group of 65+, sulfonylurea (SU) drugs dominate 45,3% vs 35,0%, the proportion of metformin and drugs with organoprotective effects (DPP-4 inhibitors, SGLT-2 inhibitors, arGLP-1) decreases. CONCLUSION: An analysis of older patients from the all-Russian population of DM patients showed significant clinical differences characterizing the pathophysiological features of the course of DM in the elderly, which requires special attention to the aspects of individualization of treatment goals and choice of therapy from the standpoint of safety and risk reduction in this cohort of patients.

BACKGROUND: To date, the results of Metformin, Gosogliptin and combination thereof have not been studied on a large patient population with type 2 diabetes mellitus (DM2), including comorbid patients, in real clinical settings in the Russian Federation.AIM: The aim is to evaluate the efficacy, safety, treatment adherence and satisfaction of patients with DM2 with the use of Metformin and Gosogliptin sugar-lowering drugs and combination thereof in routine clinical practice.MATERIALS AND METHODS: The nationwide PALITRA multicenter observational study was conducted among patients with DM2 who were prescribed therapy with Metformin or Gosogliptin or combination thereof in everyday clinical practice. Groups were formed according to the sugar-lowering drug administered; a total of 5741 patients aged 18 to 65 years with DM2 and a wide comorbidity profile participated. The observation period was 6 months. Body weight, body mass index (BMI), blood pressure (BP), glycated hemoglobin (HbA1c) level, glycemic parameters, and biochemical parameters (ALT, AST and plasma creatinine) were recorded initially and 3 and 6 months after the initiation of therapy with the study drugs. Adherence to therapy and patient and physician satisfaction with the treatment were assessed using Likert scale.RESULTS: HbA1c level decreased by 1.03% in the Metformin monotherapy group and by 0.95% in the Gosogliptin monotherapy and Metformin and Gosogliptin combination therapy groups by Week 24. By the end of the study, 49.6% of patients with DM2 reached the target HbA1c level (<7.0%). The proportion of patients with HbA1c level <7.0% was 61.0% in the Metformin group, 47.75% and 47.2% in the Gosogliptin and Metformin/Gosogliptin dual combination therapy groups, respectively. The incidence of hypoglycemic episodes was very low throughout the whole period of observation, during which body weight decreased slightly. High satisfaction of patients and physicians with DM2 treatment was shown. This was reflected by high Likert scale scores.CONCLUSION: It has been proved that Metformin, Gosogliptin and the combination of Metformin and Gosogliptin were highly effective and safe (low incidence of hypoglycemia and no effect on body weight), and patients and physicians had been satisfied with the sugar-lowering therapy in a sufficient number of Russian patients with DM2 and a wide comorbidity profile.

The increase in the number of patients with type 2 diabetes mellitus (T2D) and mortality among them forces us to look for ways to optimize T2D treatment. At the same time, more than half of patients with an established diagnosis do not reach the glycemic targets and require intensification of therapy. Due to the progressive deterioration of the glycemic status, almost one in five T2D patients requires insulin therapy (IT), and over time, IT intensification with titration of the dose of insulin. This approach is limited by a few adverse effects such as: an increased risk of severe hypoglycemia, weight gain, decreased sodium excretion, which means fluid retention in the body, and the patient’s unwillingness to carry out complex therapy regimens. The addition of sodium-glucose cotransporter 2 (SGLT2i) inhibitor with an insulin–independent mechanism of action to the treatment is aimed to solve the problem of optimizing glycemic control in this category of T2D patients. The purpose of this network meta-analysis (NMA) was to indirectly compare the efficacy and safety of SGLT2 inhibitors added on top of insulin in T2D patients. The analysis included randomized clinical trials in which dapagliflozin, empagliflozin, ipragliflozin, luseogliflozin, and ertugliflozin were prescribed as SGLT2i. The primary endpoint was a change in glycated hemoglobin (HbA1c), and the secondary endpoints were changes in a mean of fasting plasma glucose, body weight and blood pressure, as well as the mean change in daily dose of insulin. The analysis of safety data included a comparative assessment of the incidence of hypoglycemia, reproductive tract and urogenital infections, and hypovolemia. The results of the conducted NMA demonstrate the comparable effectiveness of various SGLT2i regarding managing of glycemic status in T2D patients receiving insulin, along with commensurate safety and tolerability of therapy.

BACKGROUND: Molecular genetic testing (MGT) is increasingly accessible, improving diagnosis of monogenic diabetes (DM), particularly maturity-onset diabetes of the young (MODY). While most MODY research focuses on pediatric populations, diagnosis is possible after age 18. The Federal Diabetes Registry (FDR) offers unique insights into real-world management of MODY patients.AIM: To analyze the clinical features of DM onset, carbohydrate metabolism, complications, and hypoglycemic therapy (HT) in patients with the main types of MODY based on the FDR data.MATERIALS AND METHODS: A cross-sectional analysis of the FDR was conducted. All patients with registered MODY diagnoses (MODY-1, MODY-2, MODY-3, or other) as of June 1, 2023, were included. The specified MODY type was considered indicative of prior MGT. Direct MGT results are not recorded in the FDR.RESULTS: The study included 640 patients. MODY2 was the most prevalent type (69.4%), followed by MODY1 (18.2%) and MODY3 (12.4%). The median age of DM diagnosis was 19 years for MODY1, 10 years for MODY2, and 14 years for MODY3. The majority of patients (71.4%) were diagnosed with MODY before the age of 18 years.While 61% of MODY2 patients received monotherapy with diet, others received various ADT. Sulfonylureas were commonly prescribed for MODY3 patients (45.8%), and for a smaller portion of MODY1 patients (14.1%). Insulin therapy was more frequent in MODY1 and 3 (35.9% and 31.2%, respectively). The target glycated hemoglobin level was achieved in 82% of MODY2 patients and in 50.7% and 52.9% of MODY1 and 3 patients, respectively.Diabetic complications were observed in 6.04% of MODY2 patients, 23.0% of MODY1 patients, and 22.0% of MODY3 patients. Specific complications included diabetic retinopathy (5.75%, 1.21%, and 3.39% in MODY1, MODY2, and MODY3, respectively), diabetic nephropathy (10.3%, 2.11%, and 11.9%), and diabetic polyneuropathy (14.9%, 4.53%, and 15.3%).CONCLUSION: The FDR analysis revealed real-world practice patterns in MODY management, highlighting a lack of standardized treatment approaches and potentially unnecessary insulin use. These findings, coupled with an expected rise in MODY diagnoses, underscore the need for clinical guidelines for this population.