Clinical evaluation of the implementation of the first pilot Russian integrated program for an integrated approach to the management of diabetes mellitus “NORMA”

BACKGROUND: Despite progress in the treatment of patients with diabetes mellitus (DM), the problem of achieving target values of glycemic control remains relevant. In this regard, the search for new integrated solutions that could strengthen disease control and improve clinical outcomes becomes relevant.AIM: To assess the impact of the developed integrated approach to disease management on the clinical and metabolic outcomes of patients with type 1 (T1DM) and type 2 diabetes mellitus (T2DM) participating in the “NORMA” pilot program for 3 and 6 months.MATERIALS AND METHODS: “NORMA” is the first Russian program designed to implement an integrated approach to DM management combines structured online education, blood glucose monitoring, supervision by endocrinologist, and administrative support. Interium retrospective analysis analysis of pre-existing data generated in the Program was performed from October 2020 to November 2021. Adults (≥18 years) with uncontrolled T1DM or T2DM on insulin (HbA1c>7,0%) with duration of DM ≥6 months were included. The following characteristics were considered: social-demographic parameters, duration of DM, complications, HbA1c, hypoglycemia events, daily insulin dose, patients’ perception of DM checklist (scaled 1-10), level of DM knowledge (questionnaire of 20 points).RESULTS: Data from 185 persons were analyzed: 132 with T1DM and 53 with T2DM, 67% women, the mean age was 41.3±14.4 years; the median DM duration was 12.0 [6.0; 19.0] years, 30 persons (16.3%) were free of any DM complications. Mean HbA1c decreased from 8.8±1.5% to 7.4±1.2% at month 3, and to 7.6±1.5% at month 6 (p<0.001). HbA1c <7.0% was achieved in 38.9% and 38.1% participants after 3 and 6 months, respectively. The total insulin dose has not changed within the program. The DM knowledge level after 3 months of Program increased significantly by 25.4±15.0% (p<0.001). The mean scores of patients’ perceptions of DM after 3 and 6 months increased by 2.1±10.2 % and 2.4±11.0 % (p<0.01), but the median scores (interquartile range) did not change: 0.00% (-3.00–6.00%) and 0.50% (-3.00–9.00%) respectively.CONCLUSION: In a real-life setting, the implementation of an integrated approach to the diabetes management was associated with the improvement of glycemic control without significant changes of total insulin dose

Calculus of variations and optimal control

The theory of a Pontryagin minimum is developed for problems in the calculus of variations. The application of the notion of a Pontryagin minimum to the calculus of variations is a distinctive feature of this book. A new theory of quadratic conditions for a Pontryagin minimum, which covers broken extremals, is developed, and corresponding sufficient conditions for a strong minimum are obtained. Some classical theorems of the calculus of variations are generalized

Development of forest genetics in Russia

The history of the development of forest genetics in Russia has been poorly studied, although the information obtained in this field is of great importance for research, both in general genetics and in forest science. Practically the first attempt was made to present materials on this topic. The review of publications of Russian researchers in such sections of forest genetics as population genetics (isoenzyme and DNA polymorphism analysis), karyology and cytogenetics, phenetics, genetics of quantitative features, induced mutagenesis, and genomics is presented. The applied methods are analyzed, and the main results of the studies obtained in each of these directions are summarized. In most detail, with the involvement of a large number of literature sources, studies in the field of population genetics, karyology and cytogenetics have been examined. It was noted that a limited amount of publication did not allow reflection of studies in a number of other areas of forest genetics, for example, in the development of the genetic basis for the resistance of forest woody plants to pathogens and insect pests. The review focuses on the genetics of forest-forming coniferous species that grow in Russia: Scots pine, Siberian stone pine, larch and spruce species, Siberian fir, and some other species. The importance of the conducted studies not only for the genetic analysis of the species reviewed, but also for the identification of other features of their biology is shown. An outstanding role of L. F. Pravdin and Yu. P. Altukhov in the development of Russian forest geneticists was noted. The emergence of new trends in genetics, in particular, epigenetics, poses new difficult but promising tasks for forest geneticists