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Sulfonylurea (SU) are an effective class of oral hypoglycemic drugs that have been used in clinical practice for more than 70 years. Despite the common mechanism of action, members of the class have significant intraclass differences in hypoglycemic activity, safety, and the presence of extrapancreatic effects. This review examines the features of gliclazide modified release (MR), its differences from other representatives of the SU and its place in modern recommendations for the treatment of type 2 diabetes mellitus. Gliclazide MR belongs to the modern 2nd generation SU with high hypoglycemic activity, low risk of hypoglycemia due to reversible binding to the SUR1 receptor and no effect on the Epac2 pathway, generally neutral effect on weight, proven nephroprotective properties and cardiovascular safety, which makes it possible to highlight it among representatives of the SU class. International and national clinical guidelines indicate the place of SU when it is necessary to intensify glucose-lowering therapy and glycemic control in patients with type 2 diabetes mellitus.

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

TThe annual increase in the prevalence of type 2 diabetes mellitus emphasizes the relevance of the search for new treatment options, along with necessity for regular review of proven therapeutic solutions. Today, dipeptidyl peptidase-4 inhibitors (DPP-4i, gliptins) are effective and safe hypoglycemic therapy, which is included in modern standards of treatment of type 2 diabetes. In 2022, the availability of this group of drugs for Russian patients has significantly increased. This circumstance became a prerequisite for holding a National Council of Experts with the participation of members of the Russian Association of Endocrinologists. The task of the Council was to determine the place of DPP-4i in the treatment of patients with type 2 diabetes in 2023. During the meeting of the Council, experts summarized the evidence base of DPP-4i taking into account the latest scientific data and determined the optimal clinical portraits of patients for the use of DPP-4i in accordance with updated national recommendations.

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

Over the past 10 years of studying the complications of type 2 diabetes mellitus (DM) and ways to deal with them, significant progress has been made in one of the most important areas of treatment — the prevention of cardiovascular and renal complications. Thus, when using inhibitors of type 2 sodium-glucose cotransporter, a significant reduction in the risks of cardiovascular mortality and progression of chronic heart failure, which occupy the main place in the structure of mortality in this cohort of patients, as well as a positive effect on diabetic nephropathy, one of the most common complications of type 2 diabetes, has been proven. However, there are other complications that significantly affect the duration and quality of life of patients. In particular, these include stroke, which occupies the 2nd-3rd place in the frequency of death of people with type 2 diabetes, and albuminuria, a frequent manifestation of diabetic kidney disease, which is associated with an increased risk of cardiovascular complications (including stroke) and chronic renal failure. Recent studies indicate the important role of sodium-glucose cotransporter type 1 in the development of these complications. Canagliflozin has the highest affinity for these transporters among iSGLT-2 registered in the Russian Federation. This article aims to evaluate the mechanisms of action of canagliflozin and its possible role in the prevention of stroke and albuminuria.

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.

Fasting during the Islamic Ramadan month is one of the five obligatory pillars for each adult, healthy, and sane Muslim. People with severe illnesses, including type 1 and type 2 diabetes mellitus are exempt from fasting. However, many Muslims often insist on Ramadan participating despite any medical advises. It’s known that Muslims are the second largest religious group in Russia; thus, its crucial to have as much modern recommendation for management patients with type 1 and type 2 diabetes mellitus as possible. The aim of this narrative review is to evaluate physiological and pathophysiological metabolism changing during holy Ramadan month, to clarify the management of patients with type 1 and type 2 diabetes mellitus during Ramadan, to determine the frequency of glucose measuring during the day, and to understand when its time to interrupt the fasting. Moreover, we discuss specific recommendations in glucose-lowering therapy changing, nutrition, physical activities and education.

Modern strategies for the treatment of type 2 diabetes mellitus involve the use of pathogenetically based approaches aimed at achieving optimal glycemic control and its long-term retention. Timely and rational use of 9 classes of hypoglycemic drugs, including as part of combination therapy, makes it possible to achieve significant success in diabetes therapy. One of the fundamental principles in the treatment of type 2 diabetes mellitus is the effect on insulin resistance. For this purpose, two groups of drugs are used: biguanides and thiazolidinediones (glitazones). The action of glitazones is directly related to an increase in the sensitivity of insulin-dependent tissues to insulin and a pronounced decrease in hyperinsulinemia in patients with type 2 diabetes. Of particular interest are the pathways of insulin signal transduction, the mechanisms of insulin resistance, and the possibilities of pathogenetic therapy with thiazolidinediones. Pioglitazone is currently the only available member of the thiazolidinedione class in the world, allowing to expand the management of diabetes mellitus by reducing insulin resistance in muscle and adipose tissue and glucose production by the liver. Its use can have a number of pleiotropic effects, including on cardiovascular diseases and non-alcoholic fatty liver disease, which expands the priorities for choosing hypoglycemic therapy in patients with type 2 diabetes at various stages of therapy.

A dangerous viral disease COVID-19, caused by a new RNA coronavirus SARS-COV-2, has been actively spreading in the world since December 2019. The main manifestations of this disease are bilateral pneumonia, often accompanied by the development of acute respiratory syndrome and respiratory failure. Patients with diabetes mellitus (DM) are at high risk of infection with the SARS-COV-2 virus, severe illness and death.Maintaining of target glycemic levels is the most important factor in a favorable outcome of COVID-19 in both type 1 and type 2 DM. The choice of antihyperglycemic therapy in a patient with DM in the acute period of COVID-19 depends on the initial therapy, the severity of hyperglycemia, the severity of the viral infection and the patient’s clinical condition.The article presents the recommendations of the board of experts of the Russian Association of Endocrinologists on glycemic control and the choice of antihyperglycemic therapy in patients with type 2 DM and COVID-19, and also on the use of glucocorticosteroids used in the treatment of COVID-19 in patients with type 2 DM.

Inflammation plays a key role in the development and progression of type 2 diabetes (T2DM), a disease characterized by peripheral insulin resistance and systemic glucolipotoxicity. The main source of inflammation in the early stages of the disease is visceral adipose tissue (VT). Macrophages are innate immune cells that are present in all peripheral tissues, including VT. Violation of the response of VT (MT) macrophages to changes in the microenvironment underlies aberrant inflammation and the development of local and systemic insulin resistance. The inflammatory activation of macrophages is regulated at several levels: stimulation of cell surface receptors, intracellular signaling, transcription, and metabolic levels. Which are activated by the transformation of macrophages along the pro-inflammatory or anti-inflammatory pathways. Such polarization of macrophages in modern immunology is divided into classical anti-inflammatory M1 polarization and alternative anti-inflammatory M2 polarization of macrophages. The M1 / M2 ratio of macrophages in the process of inflammation ensures the resolution of inflammation at different stages of its development. The review considers the main mechanisms involved in VT inflammation and the development of insulin resistance in T2DM, supported with the participation of immunocompetent cells, M1 / M2, as well as growth factors and humoral immunity factors secreted during this process.

Sodium-glucose cotransporter-2 inhibitors are the new drugs for the treatment of type 2 diabetes mellitus. Its mechanism of action is to increase the excretion of glucose in the urine due to inhibition of reabsorption in the proximal renal tubules, which leads to a decrease in blood glucose levels. These drugs also have pleiotropic effects including reduce body weight and blood pressure, improve the lipid profile (raising high-density lipoprotein cholesterol and lowering triglyceride levels), and reduce the risk of cardiovascular death and nephroprotection. Ipragliflozin, a new representative of the class of sodium glucose cotransporter-2 inhibitors, registered in Russia, has shown effectiveness in relation to glycemic control, reducing the levels of glycated hemoglobin and fasting plasma glucose both in monotherapy and in combination with other antihyperglycemic drugs. The PRIME-V and ILLUMINATE studies have demonstrated that ipragliflozin helps to reduce insulin resistance, body weight, BMI and waist circumference, total and LDL cholesterol. Positive effects of ipragliflozin on pancreatic β-cell mass and function have been shown in animal studies. Several studies have examined the beneficial effects of ipragliflozin on the course of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus. Significant reductions in ALT and GGT levels and a decrease in the absolute percentage of liver fat have been shown. Animal studies have confirmed the effect of ipragliflozin on the histological characteristics of NASH. The review presents data on the efficacy of ipragliflozin in relation to the components of the metabolic syndrome in patients with type 2 diabetes mellitus, and also discusses the likely mechanisms of a positive effect of the drug on the course of NASH in type 2 diabetes mellitus.

Hyperglycemia in T2DM is based on three main mechanisms: insulin resistance, progressive β-cell dysfunction, and excess glucose production by the liver.The onset of T2DM is usually preceded by a long period of insulin resistance. Prescribing sugar drugs that affect different links of pathogenesis, reducing a steady decrease in glycemia. To date, in clinical practice, various combinations of hypoglycemic drugs are used, the choice of which is determined by the characteristics of the course of diabetes in the patient, the presence of concomitant diseases and complications of diabetes, as well as the dominant clinical problem. This resolution provides an expert council opinion on the feasibility of using a combination of alogliptin and pioglitazone in patients with type 2 diabetes.

AIMS: Investigation of spontaneous and induced secretion of the pro-inflammatory cytokine tumor necrosis factor-α (TNF-α) and the anti-inflammatory chemokine C-C Motif Chemokine Ligand 18 (CCL18) by monocytes isolated from blood of patients with long-term type 2 diabetes mellitus (T2DM), both with or without foot ulcers and the effect of the course use of the combined metabolic drug Kokarnit as part of complex therapy on the dynamics of the severity of symptoms of DSPN and the cytokine phenotype in patients with long-term non-healing ulcers of the lower extremities MATERIALS AND METHODS: 121 patients with T2DM, 79 without diabetic foot syndrome (DFS) and 42 patients with DFS were included. CD14+ monocytes were isolated from patients’ blood and stimulated by interferon-γ (IFN-γ) and interleukine-4 (IL-4) for induction of pro- and anti-inflammatory monocyte activation, respectively. The concentrations of TNF-α and CCL18 in the culture medium were measured using ELISA on day 1 and day 6 after cell stimulation in all patients before taking the combined metabolic drug Kokarnit. Then they were randomly allocated either to the control group (57 people), to whom Kokarnit was added to standard treatment, or to the comparison group. After a 9-day course of application of Kokarnit, the dynamics of indicators was evaluated on a TSS scale. Assessment of cytokine status was carried out in 18 people with long-term non-healing ulcerative defects of the lower extremities, on the first and ninth day of treatment. RESULTS: A correlation was found between HbA1c and levels of stimulated secretion of TNFα (r=0.726, p=0.027), CCL18 (r=-0.949, p=0.051) in patients with DSPN. In all patients with different duration of VDS, an increase in secretion of TNF-α and CCL18 was observed (p

Introduction. Nodular goiter is one of the most common endocrine disorder, and thyroid cancer takes a leading place among malignancy of the endocrine system. The aim of our study is to evaluate the prevalence and risk factors of thyroid cancer. Materials and methods: this is a retrospective case-control study that included 140 patients operated with suspected thyroid cancer according to a cytological study of fine needle aspirates in single center in 2018. All patients underwent preoperative cytological examination with interpretation of the results according to the Bethesda system, thyroid ultrasound examination, thyroid status assessment. The results of the cytological examination, as well as clinical and laboratory data were compared with the data of histological analysis. Results: According to the preoperative cytological study, 76 nodules were reported as Bethesda IV, 4 – Bethesda III, 32 – Bethesda VI, 28 – Bethesda V. According to the results of a histological examination, thyroid cancer was confirmed in 70% of patients: in 89,3% of Bethesda V and 100% in the Bethesda VI group, 52,6% of Bethesda IV, 25% of the Bethesda III. The risk of nodule malignancy was associated with such ultrasound signs as hypoechoicity, calcifications and irregular contours. Conclusions: the improvement of the methods of preoperative diagnosis of thyroid cancer should help to choose the optimal surgical strategy, reduce the number of diagnostic and repeated thyroidectomy.

For many years, interest in the issue of obesity has not faded, as obesity is now one of the most common pathologies in the world that directly affects quality of life and lifespan. Even a slight weight loss (5-10% of baseline values) in obese patients is known to improve metabolism and reduce the risk of a range of comorbidities. The article reflects the importance of comprehensive treatment of obesity, presents positive experience of using Reduxin (sibutramine in combination with microcrystalline cellulose) to reduce body weight and risk factors for cardiovascular disease in a specific clinical example in a patient with exogenous-constitutional obesity and eating disorders. The case of obesity in a young man of 24 years old is presented, when other components of the metabolic syndrome (except for arterial hypertension) were not formed. Thus, following the results of 24-week complex treatment, clinically significant reduction of body weight (by 21.7% of initial values) was observed in the patient. The data of psychological researches have shown that the patient has no increase of anxiety and depression level during treatment, but at the same time the indicators of quality of life according to the results of health questionnaire testing have improved. This clinical case corresponds to the results of the PrimaVera program and demonstrates that weight loss during sibutramine therapy in combination with microcrystalline cellulose has a positive impact on the overall health and emotional status of patients and leads to improved quality of life. Therefore, successful treatment of obesity and the maintenance of other outcomes are key to preventing cardiovascular disease.

The prevalence of T2D is steadily increasing annually, which resulted in an active search for a way to control the disease. The last decade has seen a rise in the number of new groups of glucose-lowering drugs, which not only proved effective in the management of hyperglycemia and safe against hypoglycemia, but also joined the ranks of the drugs of the first-line therapy. Among them is incretin-active agents - type 4 dipeptidyl peptidases inhibitors (IDPP-4, glyptines). Sitagliptin was the world's first approved IDPP-4, and began to be used successfully in Russia since 2007. The review presents data on the efficacy, safety (including cardiac safety) of sitagliptin use and accumulated experience of its use in the treatment of patients with type 2 diabetes.

This paper discusses the possibilities and benefits of early combination therapy and the application features of a fixed-dose combination of metformin and alogliptin (Vipdomet®) in the treatment of type 2 diabetes mellitus (DM 2).

The associations or relationship of MetS and its components with thyroid gland (TG) dysfunction are well known, and the study was aimed at establishing the clinical and functional features of the thyroid gland dysfunction combined with the metabolic syndrome. The study included 90 patients aged 18 years and older with the presence of comorbidities which included metabolic syndrome and thyroid diseases (MetS and TG); with MetS without TG dysfunction and with TG dysfunction without MetS. A comparative assessment of BMI, insulin, HOMA-IR index, lipid profile values was carried out in the studied subgroups of patients depending on the functional state of the thyroid gland. The study showed that the comorbid course of subcompensated hypothyroidism and MetS is associated with aggravation of hyperinsulinemia and insulin resistance, with a tendency towards an increase in BMI, an unfavourable shift in lipid metabolism.

A comparative analysis of the changes in the immune and genetic status in patients with metabolic syndrome (MetS) combined with thyroid pathology has been performed in comparison with patients only with MetS or thyroid gland (TG) dysfunction.Materials and methods: 90 patients were recruited and assigned to one of three groups: A group of patients with MetS and TG dysfunction; a group of patients only with MetS; group of patients only with TG dysfunction. All patients underwent immune status assessment – CD3, CD4, CD8, CD16, CD4 +/CD8 +, and tumour necrosis factor (TNF) and C-reactive protein (CRP) levels were studied in a biochemical blood test. Genetic analysis consisted in determining the frequencies of alleles and genotypes of four polymorphic markers: rs10865710 of the PPARG3 gene, rs1042713 and rs1042711 of the ADRB2 gene and rs5443 of the GNB3 gene. Results: The combination of MetS with TG dysfunction regardless of the presence or absence of autoimmune thyroid diseases was characterized by aggravation of disorders in the Tand B-cell components of immune system, an increase in IgG, CRP, and TNF levels. Genetic analysis showed frequent detection of the A allele, the AA genotype of the polymorphic marker rs1042713 of the ADRB2 gene, coding β2-adrenoreceptor in the Kazakh population.

Type 2 diabetes is a chronic progressive disease the prevalence of which is increasing. The development of new strategies for the treatment of diabetes, among which drugs that modulate the “incretin effect” are worth noting, continues. Dipeptidyl peptidase-4 inhibitors (DPP-4, gliptins) are a group of oral antidiabetic incretin drugs that enhance the glucose-induced activity of β-cells and suppress excessive glucagon secretion by pancreatic α-cells. This group of antidiabetic drugs is widespread due to a number of relevant benefits, such as neutral effect on body weight, low risk of hypoglycaemia, convenient administration scheme and good adherence to treatment. Efficacy and safety of treatment demonstrated by global multicenter trials allow for a wide use of gliptins in clinical practice.

Diabetes mellitus implies the need for self-monitoring under the supervision of the attending physician. In the conditions of increasing prevalence of diabetes, the physician’s key task is to properly educate the patient in applying the main principles of self-monitoring. Learning the principles of glycemic control with a portable glucometer is an essential component of diabetes treatment.

In the context of cardiac safety, the article discusses the prospects and benefits of a representatives of the DPP-4 inhibitors class - alogliptin (Vipidiya) for the management of hyperglycemia in patients with diabetes type 2 (T2DM).

The problem of NAFLD has been a matter of great interest among gastroenterologists, as well as endocrinologists and cardiologists. NAFLD is currently considered a component of hepatic metabolic syndrome. Understanding the multifactorial nature of NAFLD and the mechanisms of the associated diseases helps to adequately assess the prognosis of the disease and prescribe appropriate treatment.

The interdisciplinary interim experts’ council on March 3, 2016 in Moscow have considered the EMPA-REG OUTCOME trial results and suggested a number of propositions and recommendations on further empagliflozin’s cardiovascular effects investigation and its clinical application in patients with type 2 diabetes at high cardiovascular risk.

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

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.

Inhibitors of the sodium-glucose cotransporter type 2 (SGLT2i) are a modern class of antihyperglycemic drugs with an insulin-independent mechanism of action. Due to its ability to effectively lower blood glucose levels, improve a number of other cardiometabolic parameters (body weight, blood pressure, uric acid), as well as reduce cardiovascular and renal risks, SGLT2i have become drugs of choice for many of patients with type 2 diabetes mellitus (T2DM). Meanwhile, along with the generally recognized classes-effects of this group of drugs, there are intragroup features, including those associated with their different selectivity in sodium-glucose cotransporters of types 1 and 2 (SGLT1 and SGLT 2). For example, one of the most studied SGLT2i, canagliflozin, in addition to its inhibitory activity against SGLT2, can also moderately block SGLT1 in the intestine and kidneys that could give a maximum efficiency in the control glycemia and others cardiometabolic parameters. In addition, canagliflozin improves not only cardiovascular, but also renal prognosis in patients with T2DM, which is reflected in the corresponding indications in the summary of product characteristics of the drug. This document summarize the established and new data regarding the efficacy and safety of canagliflozin, as well as its place in the treatment of T2DM.

Central hypothyroidism is a rare cause of hypothyroidism, consequence of various disorders affecting pituitary (secondary) or hypothalamus (tertiary hypothyroidism). Difficulties in the diagnosis and management of patients are due to the nontypical clinical picture, frequent combination with impaired function of other pituitary hormones, difficulties in laboratory assessment in high TSH levels or low - normal T4 free levels. Diagnosis is based on a confirmed decrease in the level of free T4 with a low or normal level of TSH. The standard treatment for hypothyroidism of any etiology remains monotherapy with levothyroxine, which allows to restore the euthyroid state in most patients. The criterion for the effectiveness of therapy is to maintain the level of T4 free in the upper half of the reference norm interval. The article presents a modern understanding of epidemiology, pathogenesis and strategies for managing patients with central hypothyroidism.

Thyroid cancer is the most common malignant tumor of the endocrine system. An increase in the incidence of thyroid cancer has been noted over the past decade, mainly due to papillary cancer. The influence of environmental factors, increased availability of medical care, including sensitive diagnostic tests, such as ultrasound and fine - needle aspiration (FNA), can affect the fact of the growth of this incidence. Palpation of thyroid gland has very low diagnostic value for detecting thyroid cancer, while thyroid ultrasound and FNA can detect malignant tumors in 20% of cases. Today, the FNA is the fastest, most accurate, economically accessible, and quite safe method for cytological diagnosis of the thyroid nodules. And molecular genetic testing of FNA samples could serve as an additional reliable diagnostic tool in the case of atypia of undetermined significance.

Aim. To analyze the association between the polymorphic markers in CTLA4, TNF, IL10 and IL16 genes and the risk of manifestation of endocrine ophthalmopathy (EO) in patients with Graves’ disease (GD). Materials and methods. Case-control study included 248 patients with GD. Using polymerase chain reaction we studied the distribution of alleles and genotypes of polymorphic markers such as A60G (rs3087243) in CTLA4 gene, G(-308)A (rs1800629) in TNF gene, G(-1082)A (rs1800896) in IL10 gene, T3249C (rs4778641) in IL16 gene among 141 patients with Graves’ disease and EO and 107 patients with GD without EO. Results and discussion. The frequencies of A alleles and the AA genotypes were significantly increased and the frequencies of G alleles and the GG genotype polymorphic markers rs3087243 of CTLA4 gene and rs1800896 of IL10 gene, as well as the GG genotype polymorphic marker rs1800629 of TNF gene were reduced in patients with GD and EO. The polymorphism in CTLA4 gene was also associated with the activity and the severity of EO. The comparative analysis of the allele and genotype frequency distribution of polymorphic markers of IL16 gene did not show the significant difference. Conclusion. The risk of manifestation and the development of EO in patients with Graves’ disease can be caused by not only environmental, but also genetic risk factors.

The article is devoted to the role of self-monitoring of the level of glycemia in achieving the goals of treatment in patients with diabetes mellitus. The dependence between the compensation of carbohydrate metabolism and the level of motivation of the trained patient for the control of glycemia is shown, the necessity of regular self-monitoring of glycemia by the patient is grounded. The main methods and means used for self-monitoring of glycemia are given and their characteristics are given. The importance of teaching patients to self-control methods as a measure of preventing the occurrence of complications of diabetes mellitus is substantiated. Comparative data on the prevalence of complications in patients, both not using self-monitoring, and conducting it, are given. Teaching patients proper glycemic control with portable glucometers is an important and indispensable component of diabetes therapy.

The article presents data on the current state of the problem of iodine deficiency, as well as negative impact of iodine deficiency on the health of pregnant women and children, covering methods of iodine prophylaxis.

Aim. To analyze the associations of the rs3087243 CTLA4 polymorphism and the rs1800629 TNF polymorphism with endocrine ophthalmopathy (EOP) in ethnic Russian patients with Graves’ disease (GD). Subjects and methods. The case-control study enrolled 205 patients with GD. The distribution of alleles and genotypes of the rs3087243 CTLA4 and rs1800629 TNF polymorphisms was studied in 141 patients with GD and EOP (a GD+EOP group) and 64 patients with GD without EOP (a GD-EOP group). The polymorphic alleles were identified by polymerase chain reaction-restriction fragment length analysis. Results. The patients with GD in their history and EOP had significantly higher frequencies of A allele and AA genotype and a lower proportion of G allele and GG genotype of the rs3087243 CTLA4 polymorphism. Comparative analysis revealed no significant differences in the frequency of the alleles and genotypes of the rs1800629 TNF polymorphism. Conclusion. The rs3087243 CTLA4 polymorphism is associated with the risk of EOP in ethnic Russian patients with GD.

Iodine deficiency disorders are one of the most common problems in thyroidology and endocrinology. Due to the vulnerability to reduced consumption of iodine, a special interest in the study of the effects of iodine deficiency and its prevention are pregnant and lactating women, patients of reproductive age and children is shown.

Конец ХХ века характеризовался большими успехами в развитии диагностических методик, как биохимических, так и инструментальных, которые позволили выявить зависимость степени тяжести многих заболеваний от сопутствующего ожирения или наличия избытка массы тела. Более того, проведенные клинические исследования недвусмысленно доказали, что уменьшение избыточной массы тела приводит к снижению дозировок препаратов, применяемых при хронических заболеваниях, улучшению состояния больного и прогноза развития заболевания, снижению риска инвалидизации и смертности. Поэтому на рубеже XX-XXI веков ожирение становится не только косметологической, в большей мере медицинской и социальной проблемой, требующей решения В этой связи попытка воздействовать на один из ключевых факторов риска развития перечисленных грозных состояний, является весьма перспективной. Основная роль фармакотерапии ожирения в будущем - поддержка нормальной массы тела после достижения снижения ее за короткий период времени. Основная цель использования препаратов для длительного контроля массы тела - это возможность отмены других препаратов, которые могли бы быть назначены для предупреждения осложнений ожирения, таких как анальгетики при артритах, липостабилизирующих препаратов, антигипертензивных препаратов, пероральных сахароснижающих средств.