Opportunities and options for surrogate assessment of insulin resistance

The high prevalence of type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular diseases (CVD) determines the need for early detection and correction of key markers of cardio-metabolic risk (CMR). This prophylactic direction is closely related to metabolic syndrome (MS) based on the concept of insulin resistance (IR). At the same time, IR is the first link in the pathogenesis of T2DM and is a recognized risk factor for atherothrombosis. Therefore, early diagnosis of IR is of practical importance both for the detection of early disorders of carbohydrate metabolism (DCM) and prognosis of T2DM, and cardiological risk. Alternative indicators have been proposed for evaluating IR with the inclusion of lipid and anthropometric parameters, the diagnostic and prognostic significance of which in terms of CMR (DCM and CVD) has been evaluated in randomized clinical trials in comparison with the HOMA-IR index and clamp. The TyG index (calculated on the basis of plasma glucose and triglycerides) is consistent with the phenomenon of glucolipotoxicity with subsequent metabolic disorders in target organs. Its derivatives are proposed: TyG-WC (TyG / waist circumference) and TYG-BMI (TyG / BMI). Apply LAP indices (lipid accumulation index) and VAI (visceral obesity index), as well as TG / HDL (TG / HDL). Their ethnic and gender differences were revealed, attempts were made to calculate the cut-off points for these indices

Electroneuromyography for early diagnosis of diabetic distal polyneuropathy

BACKGROUND: Diabetic distal polyneuropathy (DDPN) is a predictor of diabetic foot syndrome development, ulcer formation and lower limb amputation. An early DDPN diagnosis is therefore relevant. AIM: To investigate the effectiveness and suitability of electroneuromyography (ENMG) for early DDPN diagnosis. MATERIALS AND METHODS: This study was performed in the Novosibirsk Research Institute of Traumatology and Orthopaedics n.a. Ya. L. Tsivyan. A total of 80 participants were examined, including 30 DM2 patients, 30 patents without carbohydrate metabolism disorders, and 20 healthy volunteers aged 20–30 years. None of the participants showed clinical signs of distal polyneuropathy (DPN). All participants underwent evaluation of neuropathy symptoms by the Neuropathy Symptom Score scale, neurological assessment using on the scale of Neuropathic Dysfunctional Score and stimulating ENMG. RESULTS: ENMG revealed the presence of neuropathy in 86.7% of DM2 patients. Moreover, among DM2 patients, 12 (40%) presented sensory DDPN, 13 (43.3%) presented sensorimotor neuropathy and 1 (3.3%) presented motor DDPN. The medial and lateral plantar nerves were the most commonly affected (p = 0.018 and p = 0.002, respectively). Among the 30 control individuals, 9 (30%) showed signs of DPN in combination with radiculopathy. ENMG - indicators of DDPN: latency and amplitude and speed for 3 sensory (n. Plantaris lateralis, n. Plantaris medialis, n. Suralis) and 2 motor nerves (n. Peroneus, n. Tibialis) were significantly worse in individuals with DM2 than in the control group, both for those with and without radiculopathy. Among participants with DM2, those sensorimotor DDPN tended to have a longer diabetes duration (p = 0.503), higher levels of HbA1c (p = 0.077) and higher BMI (p = 0.050) than those with sensory neuropathy, although the differences were not significant. CONCLUSION: This study confirms the effectiveness and suitability of ENMG for the early diagnosis of DDPN. Moreover, the optimal ENMG indices necessary for this diagnosis were identified

Materials of scientific and practical conference «Dietoogy In Practice Of Endocrinologist» at the VIII (XXV) Russian Diabetology Congress With International Participation «Diabetes Mellitus – XXIth Century Pandemia»

The scientific-practical conference Dietoogy In Practice Of Endocrinologist was held during the VIII Russian diabetology congress with international participation “Diabetes Mellitus – XXIth Century Pandemia”. It was chaired by Academician of RAS M.V. Shestakova (Moscow), Professors L.A. Ruyatkina (Novosibirsk ) and L.A. Suplotova (Tyumen). The expediency of this event was dictated by the necessity to create a unified national regulated guidelines for the diet therapy of obesity and associated diseases for the medical community and patients. The program of the meeting included a discussion about the formation of a healthy diet and its effect on the body, starting from the pregnant women, fetal development, the breastfeeding period, in the period of perimenopause and postmenopause, in the presence of concomitant pathology of heart and kidneys

Diabetes mellitus type 2 in adults

Public organization “Russian Association of Endocrinologists”. Clinical guidelines.&nbsp

Diabetes mellitus type 1 in adults

Public organization “Russian Association of Endocrinologists”. Clinical guidlines

3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial

Background: Liraglutide 3·0 mg was shown to reduce bodyweight and improve glucose metabolism after the 56-week period of this trial, one of four trials in the SCALE programme. In the 3-year assessment of the SCALE Obesity and Prediabetes trial we aimed to evaluate the proportion of individuals with prediabetes who were diagnosed with type 2 diabetes. Methods: In this randomised, double-blind, placebo-controlled trial, adults with prediabetes and a body-mass index of at least 30 kg/m2, or at least 27 kg/m2 with comorbidities, were randomised 2:1, using a telephone or web-based system, to once-daily subcutaneous liraglutide 3·0 mg or matched placebo, as an adjunct to a reduced-calorie diet and increased physical activity. Time to diabetes onset by 160 weeks was the primary outcome, evaluated in all randomised treated individuals with at least one post-baseline assessment. The trial was conducted at 191 clinical research sites in 27 countries and is registered with ClinicalTrials.gov, number NCT01272219. Findings: The study ran between June 1, 2011, and March 2, 2015. We randomly assigned 2254 patients to receive liraglutide (n=1505) or placebo (n=749). 1128 (50%) participants completed the study up to week 160, after withdrawal of 714 (47%) participants in the liraglutide group and 412 (55%) participants in the placebo group. By week 160, 26 (2%) of 1472 individuals in the liraglutide group versus 46 (6%) of 738 in the placebo group were diagnosed with diabetes while on treatment. The mean time from randomisation to diagnosis was 99 (SD 47) weeks for the 26 individuals in the liraglutide group versus 87 (47) weeks for the 46 individuals in the placebo group. Taking the different diagnosis frequencies between the treatment groups into account, the time to onset of diabetes over 160 weeks among all randomised individuals was 2·7 times longer with liraglutide than with placebo (95% CI 1·9 to 3·9, p<0·0001), corresponding with a hazard ratio of 0·21 (95% CI 0·13–0·34). Liraglutide induced greater weight loss than placebo at week 160 (–6·1 [SD 7·3] vs −1·9% [6·3]; estimated treatment difference −4·3%, 95% CI −4·9 to −3·7, p<0·0001). Serious adverse events were reported by 227 (15%) of 1501 randomised treated individuals in the liraglutide group versus 96 (13%) of 747 individuals in the placebo group. Interpretation: In this trial, we provide results for 3 years of treatment, with the limitation that withdrawn individuals were not followed up after discontinuation. Liraglutide 3·0 mg might provide health benefits in terms of reduced risk of diabetes in individuals with obesity and prediabetes. Funding: Novo Nordisk, Denmark

Multidimensional effects of metformin in patients with type 2 diabetes

In modern algorithms for the treatment of type 2 diabetes, metformin is positioned as a first-line drug, which, when the disease progresses, is universally combined with other groups of hypoglycemic drugs, including insulin. Review of literature demonstrates the multifaceted effects of metformin with its efficacy and extensive safety range, allowing the drug to be used not only for glycemic control but also for the management of cardiovascular risk factors. Here we present a retrospective study of whether cardiovascular safety of hypoglycemic drugs should be assessed, on the basis of which the idea of a vulnerable patient in the presence of diabetes can be formulated, and the necessity of joint management of such patients by an endocrinologist and cardiologist can be postulated. The mechanisms of macrovascular protection by the drug demonstrated in the UKPDS with the phenomenon of metabolic memory are analysed along with a discussion regarding their lipid-lowering and antisclerotic effects using modern analytical reviews. The features of the action of long form of the drug (Glucophage Long) are considered. The pleiotropic possibilities of metformin, the expansion of the present indications and the prospects of application as well as new hypotheses about its mechanism of action are discussed. The possible effects of the drug on the components of the gastrointestinal tractbrainliver axis are discussed, and the effects of metformin on homeostasis due to the effect on the microbiota are presented

Detemir potential applications in the treatment of diabetes during pregnancy: proven benefits and perspectives

In recent years there is notable growing prevalence of gestational and overt diabetes in pregnant women while rate of obstetric complications, neonatal morbidity, perinatal mortality in women with diabetes is maintained at the high level as compared with common population. Furhermore no doubt that fetal programming and genetic factors induce the formation of various longterm complications in infants of diabetic mothers.   There is a strong evidence that the risk of obstetric complications can be reduced by achieving adequate glycemic control, which is frequently still an elusive goal. Improved pharmacokinetic and pharmacodynamic profiles of the insulin analogs (including minimal action variability) allow to achieve a better glycemic control with lower risk of hypoglycemias compared to human insulin. The clinical benefits of detemir have been confirmed in clinical trials in pregnant women with diabetes. Detemir is the only long-acting insulin analog that has been evaluated in prospective studies in pregnant women and proved a satisfactory safety profile and the ability to achieve a lower level of fasting glycemia and advanced maturity of the fetus at delivery