An economic value of the glycated hemoglobin test in diabetes mellitus type 2 diagnosis

BACKGROUND: Diagnostic of diabetes mellitus type 2 (DM2T) in time is very actual for treatment and prevention of potential complications of illness. Fasting blood glucose test (FBG) is a widely used method of primary DM2T diagnose. Glycated hemoglobin (HbA1c) test is an alternative and used more rarely due to expensive. AIM: Modelling of comparative expenditures for DM2T control in cases of primary diagnostic by HbA1c test or FBG test usage in 20-years horizon. METHODS: Retrospective analysis of aggregated epidemiological Russian NATION study data in 810 patients with prediabetes and DM2T with both analysis performed, with sensitivity and specificity of each is detected. The simulation model of DM2T outcomes has been used for Health Technology assessment (direct and indirect costs of Diabetes control during 20 years). Three algorithms of the DM2T treatment were investigated for understanding of expenditures in case on diagnostic on-time and case of late verification with metformin, gliflozines, gliptins, Glucagon-like peptide-1 receptor agonists, basal insulin analogs and their combinations. RESULTS: FBG test has more negative results for DM2T diagnostics in compare with HbA1c analysis (77,4% and 36,5% accordingly). Amount of false negative results in FBG test in 3 times more often occurred in comparison with HbA1c. HbA1c test in 3 times more precisely than FBG test for carbon metabolism abnormalities detection. Diagnostic in time with HbA1c test in compare with late process of illness detection by FBG can cut common expenditures on 26,3-27,7% depending on treatment option due to macrovasular complications decreasing. Disability rate is expected decrease on 21% to 20-th year in case of diagnostic with HbA1c performing instead FBG test. CONCLUSION: HbA1c test has diagnostic advantages in compare with FBG test for primary investigation (dispanserization). Direct and indirect expenditures in average for one patient with DM2T on 20-years horizon including cost of drugs, analysis, complications, disabilities are less in case of diagnostic in time with HbA1c test in comparison with late diagnostics in case of FBG test execution

«DIARISK» — the first national prediabetes and diabetes mellitus type 2 risk calculator

BACKGRAUND: The need to create a national questionnaire for screening the population for disorders of carbohydrate metabolism.AIMS: Develop a highly specific and sensitive questionnaire-calculator of the risk of prediabetes (PreD) and diabetes mellitus type 2 (DM2T) based on depersonalized data of individuals who have these diagnoses confirmed in the national epidemiological study NATION.METHODS: The express method of prediabetes (PreD) and diabetes mellitus type 2 (DM2T) risks has been created, validated and proposed for clinical usage for the first time in the Russian Federation, it was based of NATION epidemiologic study database (more than 26 000 participants). The following mathematical instruments have been used: mathematic modelling, main components methodology, binary variables, correlation analysis and single-factor analysis of variance.RESULTS: Highest coefficients of logistic regression for PreD (p<0.05) were identified for age — ≥52 years old for women and ≥59 years old for men (1,48); body mass index ≥31 (0.75); waist circumference ≥100 сm for women and ≥112 cm for men (0.90). In the same time coefficients for DM2T were for for age — ≥52 years old for women and ≥59 years old for men (1,24); body mass index ≥31 (1,19), high blood fasting glucose analysis in the past (1,37); waist circumference / hip circumference ratio ≥0.85 for women and ≥0.92 for men (1,05), high blood pressure (0.69). Correlation coefficients were taken into account and score has been used for specialized questionnaire creation. Sensitivity and specificity for PreD were 83,8% and 59,3% accordingly, for DM2T — 85,4% and 73,6% accordingly. DM2T may be suspected when total score of questionnaire is 11 and higher, and PreD — when total score will be ≥7 and <11.CONCLUSIONS: The calculator based on questionnaire (DIARISK) allows to separate of potential patient for PreD and DM2T confirmation during first examination or dispanserization. A patent for innovation has been issued

Treatment of COVID19 with antimalarial medicines: clinical pharmacology analysis

The COVID-19 epidemic caused by the human coronovirus has led to completely new challenges for clinical pharmacology, and the healthcare system as a whole. By the time the infection started, there was no effective and safe therapy. In this regard, at the request of the society and medical workers, clinical trials and routine use in clinical practice were started simultaneously. This publication provides a clinicalpharmacological analysis of well-known antimalarial medicines, which became one of the first drugs for the treatment of COVID-19 almost all over the world. Pharmacodynamic and pharmacokinetic parameters are presented. Antiviral activity, including on coronavirus, were shown. The main clinical trials for June 2020 were indicated and analyzed. Recommendations and prospects for further research were given

Применение биотехнологических лекарственных средств в педиатрии на примере моноклональных антител: взгляд с позиции клинической фармакологии

The article reviews monoclonal antibodies, its structure, classifications, pharmacodynamics, pharmacokinetics, and adverse effects. There are examples for each section. Approaches to the research and criteria for drug selection in paediatrics are discussed in detail: the role of clinical trials, extrapolation and pharmacometrics. It has been shown that the differences in the pharmacokinetics of monoclonal antibodies between adults and children present due to the age-related characteristics of various physiological processes. The authors analyse such parameters as absorption, bioavailability, distribution, and elimination. The role of monoclonal antibodies immunogenicity in the structure of adverse effects in children is fully presented. Pharmacometrics is reviewed in the form of modelling and simulation in monoclonal antibodies dosing in paediatrics. It is important to consider the growth and development as “moving targets" in pediatrics regardless the principle of monoclonal antibodies dosage in children. The conclusions were made, and the guidelines were prepared based on the article results.В статье рассматриваются моноклональные антитела — их структура, классификации, фармакодинамика, фармакокинетика, нежелательные явления. Даются примеры по каждому разделу. Подробно обсуждаются подходы к изучению и критериям выбора данных лекарственных средств в педиатрии: роль клинических испытаний, экстраполяции и фармакометрии. Показано, что различия в фармакокинетике моноклональных антител между взрослыми и детьми обусловлены возрастными особенностями физиологических процессов. Авторы разбирают такие параметры, как абсорбция и биодоступность, распределение, элиминация. Подробно представлена роль иммуногенности моноклональных антител в структуре нежелательных явлений у детей. Рассмотрена фармакометрия в виде моделирования и симуляции при дозировании моноклональных антител в педиатрии. Вне зависимости от принципа определения дозы моноклональных антител у детей важно учитывать, что биология развития ребенка является «движущейся мишенью» в педиатрии. По результатам статьи сделаны выводы и даны рекомендации

Современные подходы к ведению детей с острой респираторной вирусной инфекцией

Experts of the Union of Pediatricians of Russia have developed modern guidelines on management of children with acute respiratory viral infection. The term “acute respiratory viral infection” (ARVI) combines following nosological forms: acute nasopharyngitis, acute pharyngitis, acute laryngitis, acute tracheitis, acute laryngopharyngitis, upper respiration tract infection (unspecified). The issues of epidemiology, diagnosis, treatment, and prevention have been considered in detail.Экспертами Союза педиатров России разработаны актуальные клинические рекомендации по оказанию медицинской помощи детям с острой респираторной вирусной инфекцией. Понятие «острая респираторная вирусная инфекция (ОРВИ)» суммирует следующие нозологические формы: острый назофарингит, острый фарингит, острый ларингит, острый трахеит, острый ларингофарингит, острая инфекция верхних дыхательных путей неуточненная.Подробно разобраны вопросы эпидемиологии, диагностики, лечения и профилактики