147 research outputs found
National register of diabetes mellitus in Russian Federation.
Clinical and epidemiological monitoring of diabetes in Russian Federation (RF) is carried out by the National diabetes register, which methodological and organizational reference center is Federal Endocrinology Research Centre. Since 2014 initiated the translation the National diabetes register on online software system in order to increase the effectiveness of the register as a scientific and analytical platform. The article include the analysis of DM prevalence, incidence,DM-related mortality,the prevalence of diabetic complications and analysis of effectiveness of diabetes care (included HbA1c) and according to the data of online register
Signaling pathways of Ξ²-cell death in type 2 diabetes mellitus: the role of innate immunity
Type 2 diabetes mellitus (T2DM) is a multifactorial metabolic disease, the development of which is mediated by both genetic disorders and various intracellular and extracellular molecular processes. One of the main pathogenetic mechanisms for the development of T2DM is a progressive decrease in the mass and functional reserve of β-cells, which largely determines the course of T2DM. The mechanisms of action of most sugar-lowering drugs are associated with increased secretion of insulin, so it is obvious that the effectiveness of the therapy will also largely depend on the functional state of β-cells. All this explains the great interest in studying the mechanisms of damage of β-cells in T2DM and factors that can accelerate this process, leading to their death and the development of a relative and then absolute insulin deficiency. The mechanisms of dysfunction β-cells in T2DM have not been studied much. This article provides an overview of the data of domestic and foreign literature of recent years on the molecular, intracellular features of various mechanisms of damage and death of β-cells in type 2 diabetes. The results of studies aimed at studying the possible factors and processes leading to their launch are presented
Liraglutid - vozmozhnosti kompleksnogo terapevticheskogo podkhoda v terapii SD 2 tipa
ΠΠ° ΡΠ΅Π³ΠΎΠ΄Π½ΡΡΠ½ΠΈΠΉ Π΄Π΅Π½Ρ, Π±Π΅Π·ΡΡΠ»ΠΎΠ²Π½ΠΎ, ΡΠ»ΠΎΠΆΠ½ΠΎ ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΠΈΡΡ ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ Π‘Π 2 ΡΠΈΠΏΠ° Π±Π΅Π· Π±Π°Π»Π°Π½ΡΠ° ΠΌΠ΅ΠΆΠ΄Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ Π³Π»ΠΈΠΊΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ ΠΈ ΠΌΠΈΠ½ΠΈΠΌΠΈΠ·Π°ΡΠΈΠ΅ΠΉ ΡΠΈΡΠΊΠ° Π³ΠΈΠΏΠΎΠ³Π»ΠΈΠΊΠ΅ΠΌΠΈΠΉ. ΠΠΎ, ΠΏΠΎΡΠ²ΠΈΠ²ΡΠ°ΡΡΡ Ρ ΠΏΡΠΈΡ
ΠΎΠ΄ΠΎΠΌ Π°Π³ΠΎΠ½ΠΈΡΡΠΎΠ² ΠΠΠ-1 Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ Π²ΠΎΠΏΠ»ΠΎΡΠ°ΡΡ Π²Π½Π΅-Π³Π»ΠΈΠΊΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΡΡΠ΅ΠΊΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ - Π²Π»ΠΈΡΠ½ΠΈΠ΅ Π½Π° ΠΊΠ°ΡΠ΄ΠΈΠΎ-ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ°ΠΊΡΠΎΡΡ ΡΠΈΡΠΊΠ°: ΠΠ, ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°, Π»ΠΈΠΏΠΈΠ΄Ρ, Π° ΡΠ°ΠΊΠΆΠ΅, ΠΏΠΎΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° ΠΊΠ»ΡΡΠ΅Π²ΡΡ ΠΏΠΎΠ»ΠΎΠΌΠΊΡ? - ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΡΡΡΠ΅Π΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠ½ΠΊΡΠΈΠΈ Π±Π΅ΡΠ°-ΠΊΠ»Π΅ΡΠΎΠΊ, Π±Π΅Π· ΡΠΎΠΌΠ½Π΅Π½ΠΈΡ, ΠΎΡΠΊΡΡΠ²Π°Π΅Ρ Π½ΠΎΠ²ΡΠΉ ΡΡΠ°ΠΏ Π² ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π‘Π 2 ΡΠΈΠΏΠ°. ΠΡΠ»ΠΈ ΠΊΠΎΡΠΎΡΠΊΠΎ ΡΡΠΌΠΌΠΈΡΠΎΠ²Π°ΡΡ Π²ΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΡΡΠ΅ΠΊΡΡ, ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π½Π½ΡΠ΅ Π² ΠΏΡΠΎΠ³ΡΠ°ΠΌΠΌΠ΅ LEAD, ΠΌΠΎΠΆΠ½ΠΎ ΡΡΠ²Π΅ΡΠΆΠ΄Π°ΡΡ, ΡΡΠΎ ΡΡΡΠ΅ΠΊΡΡ Π»ΠΈΡΠ°Π³Π»ΡΡΠΈΠ΄Π° Π²ΡΡ
ΠΎΠ΄ΡΡ Π΄Π°Π»Π΅ΠΊΠΎ Π·Π° ΡΠ°ΠΌΠΊΠΈ ΡΡΠ°Π΄ΠΈΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ΠΈΡ ΠΎ ΡΠ°Ρ
Π°ΡΠΎΡΠ½ΠΈΠΆΠ°ΡΡΠ΅ΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ: Π½Π°ΡΡΠ΄Ρ Ρ ΡΠ΅ΠΌ, ΡΡΠΎ ΠΎΡ 52 Π΄ΠΎ 65% ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π΄ΠΎΡΡΠΈΠ³Π°ΡΡ ΡΠ΅Π»Π΅ΠΉ HbA1c < 7% ΠΏΡΠΈ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΌ ΡΠΈΡΠΊΠ΅ Π³ΠΈΠΏΠΎΠ³Π»ΠΈΠΊΠ΅ΠΌΠΈΠΉ, Π»ΠΈΡΠ°Π³Π»ΡΡΠΈΠ΄ Π²ΡΠ·ΡΠ²Π°Π΅Ρ Π±ΡΡΡΡΠΎΠ΅ ΠΈ ΡΡΡΠΎΠΉΡΠΈΠ²ΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΌΠ°ΡΡΡ ΡΠ΅Π»Π°, ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈ Π·Π½Π°ΡΠΈΠΌΠΎΠ΅ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΠΈΡΡΠΎΠ»ΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄Π°Π²Π»Π΅Π½ΠΈΡ, ΠΈ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΡΡΠ½ΠΊΡΠΈΠΈ Π±Π΅ΡΠ°-ΠΊΠ»Π΅ΡΠΎΠΊ. Π’Π°ΠΊΠΈΠΌ ΠΎΠ±ΡΠ°Π·ΠΎΠΌ, ΠΏΠΎ ΠΌΠ΅ΡΠ΅ Π²Π½Π΅Π΄ΡΠ΅Π½ΠΈΡ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΡΡ ΠΏΡΠ°ΠΊΡΠΈΠΊΡ Π°Π½Π°Π»ΠΎΠ³Π° ΡΠ΅Π»ΠΎΠ²Π΅ΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΠΠ-1, Π²ΡΠ°ΡΠΈ ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡ ΠΏΠΎΠ»ΡΡΠ°Ρ Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ ΡΠ΅Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΎΡΡΠ°ΠΆΠ΅Π½ΠΈΡ ΡΠ΅Π»ΠΎΠ³ΠΎ ΡΡΠ΄Π° ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΡΡΡΠ΅ΠΊΡΠΎΠ² Π½Π°ΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΠΠΠ-1. Π, ΡΠ΅ΠΌ ΡΠ°Π½ΡΡΠ΅, Π½Π° Π±ΠΎΠ»Π΅Π΅ ΡΠ°Π½Π½Π΅ΠΌ ΡΡΠ°ΠΏΠ΅ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ, ΠΌΠΎΠΆΠ΅Ρ Π±ΡΡΡ ΠΏΡΠ΅Π΄ΠΎΡΡΠ°Π²Π»Π΅Π½Π° ΡΡΠ° Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ, ? ΡΠ΅ΠΌ Π»ΡΡΡΠ΅
Experience with sitagliptin (the first DPP-4 inhibitor) application to the treatment of type 2 diabetes mellitus in the Russian Federation:Results of the DIA-DA observation program
This paper reports results of the DIA-DA observation program designed to study the efficacy and safety of the DPP-4 inhibitor sitagliptin added tometformin therapy in different regions of the Russian Federation. The study included 923 patients with DM2 (mean duration 4.5 years) uncontrolledby diet and metformin monotherapy. They were transferred to the combined treatment with sitagliptin and metformin during 6 months. The mainend-points assessed in the study were hypoglycemic efficiency, frequency of side-effects, and satisfaction of patients and physicians with the treatment.The target HbA1c leve
The role of the tissue renin-angiotensin-aldosterone system in the development of metabolic syndrome, diabetes mellitus and itsvascular complications
Renin-angiotensin-aldosterone system (RAAS) is a major system of the human body playing a key role in the regulation of most physiological andpathological conditions, such as vascular tone, AD level, myocardial and vascular wall remodeling, development of atherosclerosis, glomerulosclerosis,and other pathologies. The discovery of local (tissue) RAAS in the late XX century gave evidence of direct synthesis of all components of this system,from renin to aldosterone, in target tissues and organs. Activation of tissue RAAS was shown to play a leading role in the evolvement of diabetic complicationsincluding cardiovascular diseases, diabetic nephropathy (DN), and retinopathy. Recent studies revealed the presence of RAAS componentsin fat and pancreas. This system is involved in the development of visceral obesity, pre-diabetes, and Type 2 diabetes. These findings are confirmedby a reduced risk of CDM2 in subjects receiving long-term therapy with RAAS blockers
Actual ambulatory care in patients with type 2 diabetes mellitus in Russian Federation according to open label prospectiveobservational study DIA-CONTROL
This review presents a comprehensive analysis of actual ambulatory care in patients with type 2 diabetes mellitus provided in 10 federal subjects withinthe period of 1 year. The analysis is based on results from non-interventional open label prospective observational study DIA-CONTROL, whichincluded 9844 patients with DM type 2. The study was aimed to assess the initial level of glycated hemoglobin and its further dynamics according tomeasurements repeated every 3 months. Composition and efficiency of hypoglycemic therapy were also estimated in these patients.Inclusion visit showed 38.5% of patients to have adequate HbA1c levels (8%, which is quite disturbing and suggests a more careful approach to instruction of healthcarespecialists
Diabeticheskaya nefropatiya: itogi XX veka, perspektivy XXI veka
Π ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΡΠ»Π΅Π΄Π½Π΅Π³ΠΎ Π΄Π΅ΡΡΡΠΈΠ»Π΅ΡΠΈΡ Π² Π‘Π¨Π ΠΈ ΡΡΠ΄Π΅ ΡΡΡΠ°Π½ ΠΠ²ΡΠΎΠΏΡ ΠΈ ΠΠ·ΠΈΠΈ ΠΠ Π²ΡΡΠ»Π° Π½Π° ΠΏΠ΅ΡΠ²ΠΎΠ΅ ΠΌΠ΅ΡΡΠΎ ΠΏΠΎ ΠΏΠΎΡΡΠ΅Π±Π½ΠΎΡΡΠΈ Π² Π·Π°ΠΌΠ΅ΡΡΠΈΡΠ΅Π»ΡΠ½ΡΡ
Π²ΠΈΠ΄Π°Ρ
ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΠΈ (Π³Π΅ΠΌΠΎΠ΄ΠΈΠ°Π»ΠΈΠ· ΠΈΠ»ΠΈ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ ΠΏΠΎΡΠΊΠΈ). ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΠΎΠ±ΠΎΡΠ½ΠΎΠ²Π°Π½Π½ΡΠΌΠΈ ΠΈ Π΄ΠΎΠΊΠ°Π·Π°Π½Π½ΡΠΌΠΈ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠ°ΠΌΠΈ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠ ΡΠ²Π»ΡΡΡΡΡ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ΅ΡΠΈΠ΅ ΡΠ°ΠΊΡΠΎΡΡ (Π³ΠΈΠΏΠ΅ΡΠ³Π»ΠΈΠΊΠ΅ΠΌΠΈΡ ΠΈ Π³ΠΈΠΏΠ΅ΡΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΡ) ΠΈ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ (Π²Π½ΡΡΡΠΈΠΊΠ»ΡΠ±ΠΎΡΠΊΠΎΠ²Π°Ρ ΠΈ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ). ΠΠΌΠ΅Π½Π½ΠΎ Π³ΠΈΠΏΠ΅ΡΠ³Π»ΠΈΠΊΠ΅ΠΌΠΈΡ ΠΏΡΠΈΠ²ΠΎΠ΄ΠΈΡ ΠΊ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡΠΌ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½ΠΈ - Π΄ΠΈΡΡΡΠ·Π½ΠΎΠΌΡ ΠΈΠ»ΠΈ ΡΠ·Π΅Π»ΠΊΠΎΠ²ΠΎΠΌΡ Π³Π»ΠΎΠΌΠ΅ΡΡΠ»ΠΎΡΠΊΠ»Π΅ΡΠΎΠ·Ρ. ΠΠΈΠΊΡΠΎΠ°Π»ΡΠ±ΡΠΌΠΈΠ½ΡΡΠΈΡ (ΡΠΊΡΠΊΡΠ΅ΡΠΈΡ Ρ ΠΌΠΎΡΠΎΠΉ ΠΎΡ 30 Π΄ΠΎ 300 ΠΌΠ³ Π°Π»ΡΠ±ΡΠΌΠΈΠ½Π° Π² ΡΡΡΠΊΠΈ) ΠΏΡΠΈΠ·Π½Π°Π½Π° ΡΠ°ΠΌΡΠΌ Π½Π°Π΄Π΅ΠΆΠ½ΡΠΌ ΠΈ Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΡΠΌ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠΌ ΡΠ°Π·Π²ΠΈΠ²Π°ΡΡΠ΅ΠΉΡΡ ΠΠ. ΠΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΌΠΈΠΊΡΠΎΠ°Π»ΡΠ±ΡΠΌΠΈΠ½ΡΡΠΈΠΈ ΡΠ΅ΠΏΠ΅ΡΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΎΠ±ΡΠ·Π°ΡΠ΅Π»ΡΠ½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΎΠ±ΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ Π²ΡΠ΅Ρ
Π±ΠΎΠ»ΡΠ½ΡΡ
Π‘Π 1 ΠΈ 2 ΡΠΈΠΏΠΎΠ² ΠΏΡΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΈΠΈ ΠΏΡΠΎΡΠ΅ΠΈΠ½ΡΡΠΈΠΈ. Π‘Π°ΠΌΠ°Ρ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½Π°Ρ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ° ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΠ - ΡΡΠΎ ΠΈΠ΄Π΅Π°Π»ΡΠ½Π°Ρ ΠΊΠΎΠΌΠΏΠ΅Π½ΡΠ°ΡΠΈΡ ΡΠ³Π»Π΅Π²ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΠΎΠ±ΠΌΠ΅Π½Π° Π½Π° Π²ΡΠ΅ΠΌ ΠΏΡΠΎΡΡΠΆΠ΅Π½ΠΈΠΈ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΠΏΠ΅ΡΠ²ΡΠ΅ Π½Π° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΏΠΎΠ»ΡΡΠ΅Π½Ρ Π΄Π°Π½Π½ΡΠ΅ ΠΎΠ± ΠΎΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΠΎΠΌ ΡΠ΅Π»Π΅Π²ΠΎΠΌ ΡΡΠΎΠ²Π½Π΅ ΠΠ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡΡΠ΅ΠΌ Π·Π°ΡΠΎΡΠΌΠΎΠ·ΠΈΡΡ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΏΡΠΈ Π‘Π: ΠΠ ΠΏΡΠΈ Π‘Π < 130/80 ΠΌΠΌ ΡΡ.ΡΡ. ΠΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΡ ΠΠΠ€ ΡΠ²Π»ΡΡΡΡΡ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ ΠΏΠ΅ΡΠ²ΠΎΠ³ΠΎ ΡΡΠ΄Π° Π²ΡΠ±ΠΎΡΠ° Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π½Π΅ΡΡΠΎΠΏΠ°ΡΠΈΠΈ ΠΏΡΠΈ ΠΎΠ±ΠΎΠΈΡ
ΡΠΈΠΏΠ°Ρ
Π‘Π.
Π ΠΏΠ΅ΡΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°?ΡΠ°ΠΌ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΠ, ΠΏΡΠΎΡ
ΠΎΠ΄ΡΡΠΈΠΌ Π² Π½Π°ΡΡΠΎΡΡΠ΅Π΅ Π²ΡΠ΅ΠΌΡ ΡΡΠ°Π΄ΠΈΠΈ ΡΠΊΡΠΏΠ΅ΡΠΈΠΌΠ΅Π½ΡΠ°Π»ΡΠ½ΡΡ
ΠΈ/ΠΈΠ»ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ, ΠΎΡΠ½ΠΎΡΡΡ: ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ, Π±Π»ΠΎΠΊΠΈΡΡΡΡΠΈΠ΅ Π°ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ "ΠΌΠ΅Π΄ΠΈΠ°ΡΠΎΡΠΎΠ²" ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΡΠΊΠ°Π½ΠΈ ΠΏΠΎΡΠ΅ΠΊ, ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ, Π²ΠΎΠ·Π΄Π΅ΠΉΡΡΠ²ΡΡΡΠΈΠ΅ Π½Π° ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΠ·ΠΌ ΠΈ Π±ΠΈΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠΎΡΡΠ°Π² Π±Π°Π·Π°Π»ΡΠ½ΡΡ
ΠΌΠ΅ΠΌΠ±ΡΠ°Π½ ΠΏΠΎΡΠ΅ΡΠ½ΡΡ
ΠΊΠ»ΡΠ±ΠΎΡΠΊΠΎΠ², ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π³Π΅Π½Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΠΠ. ΠΠ΅ΡΡΠΎΠΏΠ°ΡΠΈΡ ΠΏΡΠΈ Π‘Π Π½Π΅ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠ°ΡΠ°Π»ΡΠ½ΠΎΠΉ Π½Π΅ΠΈΠ·Π±Π΅ΠΆΠ½ΠΎΡΡΡΡ. ΠΠΌΠ΅ΡΡΠΈΠ΅ΡΡ ΠΌΠ΅ΡΠΎΠ΄Ρ Π²ΠΎΠ·Π΄Π΅ΠΉΡΡΠ²ΠΈΡ Π½Π° ΠΏΠΎΠ²ΡΠ΅ΠΆΠ΄Π°ΡΡΠΈΠ΅ ΡΠ°ΠΊΡΠΎΡΡ ΡΠΏΠΎΡΠΎΠ±Π½Ρ ΠΎΡΡΠ°Π½ΠΎΠ²ΠΈΡΡ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΠΎΠ³ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΡ
Efficacy and safety of treatment with human insulin analogues in daily management of insulin naive patients with type 2 diabetes mellitus: results of multicenter 52-week observational study A1chive
Modern insulin analogues allow safe improvement of glycemic control (not accompanied with increase in body mass or rate of severe hypoglycemic events) and its efficient maintenance during long period of time. In this paper we present results of multicenter 52-week prospective observational study A1chive (Russian cohort, n=9342), designed to assess safety and efficacy of treatment with human insulin analogues (Levemir?, NovoMix? 30 and NovoRapid? (Novo Nordisk) in daily management of insulin naive patients with type 2 diabetes mellitus. Prescription of human insulin analogues resulted in clinically and statistically significant improvement of glycemic control irrespective of initial insulin regimen. Therapy by various regimens (Levemir?, NovoMix? 30 or Levemir? + NovoRapid?) under conditions of daily clinical practice leads to marked improvement in glycemic control as measured by HbA1c (-2.9% in 12 month) with no evidence for negative influence on tolerability and short-term safety of the treatment. Furthermore, decrease in HbA1c levels was associated with pronounced and stable decrease in fasting and postprandial glucose levels (-5.0 mmol/L and -5.7 mmol/L, respectively). By the end of the follow-up all regimen groups reported improvement of QoL by treatment satisfaction criterion
Mozhno li izbezhat' polipragmazii pri insulinzavisimom sakharnom diabete?
ΠΠΎΠ»ΠΈΠΏΡΠ°Π³ΠΌΠ°Π·ΠΈΡ - ΠΎΠ΄Π½ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ΅ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π±ΠΎΠ»ΡΠ½ΠΎΠΌΡ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π° Π»Π΅ΠΊΠ°ΡΡΡΠ² ΠΈΠ»ΠΈ Π»Π΅ΡΠ΅Π±Π½ΡΡ
ΠΏΡΠΎΡΠ΅Π΄ΡΡ. ΠΡΠ° ΡΠΈΡΡΠ°ΡΠΈΡ Π²ΠΎΠ·Π½ΠΈΠΊΠ°Π΅Ρ Π² ΡΠΎΠΌ ΡΠ»ΡΡΠ°Π΅, Π΅ΡΠ»ΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΎΠ΄Π½ΠΎΠΌΠΎΠΌΠ΅Π½ΡΠ½ΠΎ ΠΈΠΌΠ΅ΡΡΡΡ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΡ Π½Π΅ΡΠΊΠΎΠ»ΡΠΊΠΈΡ
ΠΎΡΠ³Π°Π½ΠΎΠ² ΠΈ ΡΠΈΡΡΠ΅ΠΌ (ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ, ΠΏΠΈΡΠ΅Π²Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ, ΠΌΠΎΡΠ΅Π²ΡΠ΄Π΅Π»ΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ, Π½Π΅ΡΠ²Π½ΠΎΠΉ ΠΈ Π΄Ρ.). ΠΠ°ΠΈΠ±ΠΎΠ»Π΅Π΅ ΡΠ°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΠΌ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΠΎΠΌ ΠΊ Π»Π΅ΡΠ΅Π½ΠΈΡ Π»ΡΠ±ΠΎΠ³ΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΈΠ»ΠΈ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ. Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΠΎΠΉ ΠΌΠ°ΡΡΠΎΠΉ ΡΠ΅Π»Π° Π²Π΅Π΄ΡΡΠΈΠΌ Π΄Π΅ΡΠ΅ΠΊΡΠΎΠΌ, Π²ΡΠ·ΡΠ²Π°ΡΡΠΈΠΌ ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ ΡΠ°Ρ
Π°ΡΠ° Π² ΠΊΡΠΎΠ²ΠΈ, ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π°ΡΡΡΠ΅Π½ΠΈΠ΅ ΡΠ΅ΠΊΡΠ΅ΡΠΈΠΈ ΠΈΠ½ΡΡΠ»ΠΈΠ½Π° Π±Π΅ΡΠ°-ΠΊΠ»Π΅ΡΠΊΠ°ΠΌΠΈ ΠΏΠΎΠ΄ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠ½ΠΎΠΉ ΠΆΠ΅Π»Π΅Π·Ρ. ΠΠΎΡΡΠΎΠΌΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΡΠ°ΠΊΠΈΡ
Π±ΠΎΠ»ΡΠ½ΡΡ
Π΄ΠΎΠ»ΠΆΠ½ΠΎ Π±Π°Π·ΠΈΡΠΎΠ²Π°ΡΡΡΡ Π½Π° ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°Ρ
, ΡΠΏΠΎΡΠΎΠ±Π½ΡΡ
ΡΠ²Π΅Π»ΠΈΡΠΈΡΡ Π²ΡΡΠ²ΠΎΠ±ΠΎΠΆΠ΄Π΅Π½ΠΈΠ΅ ΡΠ½Π΄ΠΎΠ³Π΅Π½Π½ΠΎΠ³ΠΎ ΠΈΠ½ΡΡΠ»ΠΈΠ½Π° - ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ ΡΡΠ»ΡΡΠΎΠ½ΠΈΠ»ΠΌΠΎΡΠ΅Π²ΠΈΠ½Ρ. Π£ Π±ΠΎΠ»ΡΠ½ΡΡ
ΠΠΠ‘Π Ρ ΠΈΠ·Π±ΡΡΠΎΡΠ½ΠΎΠΉ ΠΌΠ°ΡΡΠΎΠΉ ΡΠ΅Π»Π° ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΡΠΉ Π΄Π΅ΡΠ΅ΠΊΡ ΠΎΠ±ΡΡΠ»ΠΎΠ²Π»Π΅Π½ ΠΈΠ½ΡΡΠ»ΠΈΠ½ΠΎΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΡΡΡΡ ΡΠΊΠ°Π½Π΅ΠΉ. ΠΡΠΈΠΌ Π±ΠΎΠ»ΡΠ½ΡΠΌ ΠΏΡΠ΅ΠΆΠ΄Π΅ Π²ΡΠ΅Π³ΠΎ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌΠΈ, ΡΡΡΡΠ°Π½ΡΡΡΠΈΠΌΠΈ ΠΈΠ½ΡΡΠ»ΠΈΠ½ΠΎΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΡΡΡ, Ρ.Π΅. Π²ΠΎΡΡΡΠ°Π½Π°Π²Π»ΠΈΠ²Π°ΡΡΠΈΠΌΠΈ Π½ΠΎΡΠΌΠ°Π»ΡΠ½ΡΡ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΊ ΠΈΠ½ΡΡΠ»ΠΈΠ½Ρ ΠΏΠ΅ΡΠ΅Π½ΠΈ, ΠΆΠΈΡΠΎΠ²ΠΎΠΉ ΠΈ ΠΌΡΡΠ΅ΡΠ½ΠΎΠΉ ΡΠΊΠ°Π½Π΅ΠΉ. Π ΡΠ°ΠΊΠΈΠΌ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠ°ΠΌ ΠΎΡΠ½ΠΎΡΡΡΡΡ Π±ΠΈΠ³ΡΠ°Π½ΠΈΠ΄Ρ. ΠΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΠ΅ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ ΠΈ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ, Π² ΡΠΎΠΌ ΡΠΈΡΠ»Π΅ ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ Π΄ΠΈΠ°Π±Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠΈΠ½ΠΎΠΏΠ°ΡΠΈΠΈ, Π½Π°ΡΠ»ΠΈ ΠΈΠ½Π³ΠΈΠ±ΠΈΡΠΎΡΡ Π°Π½Π³ΠΈΠΎΡΠ΅Π½Π·ΠΈΠ½ΠΏΡΠ΅Π²ΡΠ°ΡΠ°ΡΡΠ΅Π³ΠΎ ΡΠ΅ΡΠΌΠ΅Π½ΡΠ° (ΠΠΠ€). Π ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΠΈ ΠΌΠ°ΠΊΡΠΎΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠ°Ρ
Π°ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΠ°Π±Π΅ΡΠ° Π²Π΅Π΄ΡΡΡΡ ΡΠΎΠ»Ρ ΠΈΠ³ΡΠ°ΡΡ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠΎΠ½ΠΈΡ, Π³ΠΈΠΏΠ΅ΡΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΡ, ΠΎΠΆΠΈΡΠ΅Π½ΠΈΠ΅, ΠΊΡΡΠ΅Π½ΠΈΠ΅. Π ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΠΈ Π΄ΠΈΡΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΠΈ ΠΌΠ°ΠΊΡΠΈΠΌΠ°Π»ΡΠ½ΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡ ΠΏΡΠΎΠ΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΡ ΠΈΠ· Π³ΡΡΠΏΠΏΡ ΡΡΠ°ΡΠΈΠ½ΠΎΠ². Π°Π½Π°Π»ΠΈΠ· ΠΎΠ±ΡΠΈΡ
ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠ² ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΠΠ‘Π ΠΈ Π΅Π³ΠΎ ΠΌΠΈΠΊΡΠΎ - ΠΈ ΠΌΠ°ΠΊΡΠΎΡΠΎΡΡΠ΄ΠΈΡΡΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠ΄Π΅Π»Π°ΡΡ Π²ΡΠ²ΠΎΠ΄ ΠΎ ΡΠΎΠΌ, ΡΡΠΎ ΠΊΠΎΡΡΠ΅ΠΊΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠ‘Π ΠΌΠΎΠΆΠ½ΠΎ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΡ, Π½Π°Π·Π½Π°ΡΠΈΠ² Π²ΡΠ΅Π³ΠΎ Π½Π΅ΡΠΊΠΎΠ»ΡΠΊΠΎ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ²: Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΡΠΉ ΡΠ°Ρ
Π°ΡΠΎΡΠ½ΠΈΠΆΠ°ΡΡΠΈΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°Ρ, Π°Π½ΡΠΈΠ³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠ²Π½ΡΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°Ρ ΠΈ Π³ΠΈΠΏΠΎΠ»ΠΈΠΏΠΈΠ΄Π΅ΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ ΠΏΡΠ΅ΠΏΠ°ΡΠ°Ρ. Π’ΠΎΠ»ΡΠΊΠΎ Π² ΡΠ΅Π΄ΠΊΠΈΡ
ΡΠ»ΡΡΠ°ΡΡ
(Π½Π΅ Π±ΠΎΠ»Π΅Π΅ ΡΠ΅ΠΌ Π² 20%) ΠΎΠΏΡΠ°Π²Π΄Π°Π½ΠΎ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ Π±ΠΎΠ»ΡΡΠ΅Π³ΠΎ ΠΊΠΎΠ»ΠΈΡΠ΅ΡΡΠ²Π° Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½Π½ΡΡ
ΡΡΠ΅Π΄ΡΡΠ². ΠΠΎ Π²ΡΠ΅Ρ
ΠΎΡΡΠ°Π»ΡΠ½ΡΡ
ΡΠ»ΡΡΠ°ΡΡ
ΠΏΠΎΠ»ΠΈΠΏΡΠ°Π³ΠΌΠ°Π·ΠΈΡ Π½Π°Π½ΠΎΡΠΈΡ ΡΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΡΠΉ Π²ΡΠ΅Π΄ ΠΊΠ°ΠΊ Π·Π΄ΠΎΡΠΎΠ²ΡΡ Π±ΠΎΠ»ΡΠ½ΠΎΠ³ΠΎ, ΡΠ°ΠΊ ΠΈ ΡΠ΅ΠΏΡΡΠ°ΡΠΈΠΈ Π²ΡΠ°ΡΠ°, Π° ΡΠ°ΠΊΠΆΠ΅ Π½Π°Π½ΠΎΡΠΈΡ ΡΠΊΠΎΠ½ΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΠΉ Π²ΡΠ΅Π΄. ΠΠ΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ Π»Π΅ΡΠ΅Π½ΠΈΡ ΡΠΎ ΡΡΠΎΡΠΎΠ½Ρ Π²ΡΠ°ΡΠ°-ΠΊΠΎΠΎΡΠ΄ΠΈΠ½Π°ΡΠΎΡΠ°, ΠΊΠΎΡΠΎΡΡΠΌ Π² Π»Π΅ΡΠ΅Π½ΠΈΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
ΡΠ°Ρ
Π°ΡΠ½ΡΠΌ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠΌ Π±Π΅Π·ΡΡΠ»ΠΎΠ²Π½ΠΎ Π΄ΠΎΠ»ΠΆΠ΅Π½ ΡΡΠ°ΡΡ ΡΠ½Π΄ΠΎΠΊΡΠΈΠ½ΠΎΠ»ΠΎΠ³-Π΄ΠΈΠ°Π±Π΅ΡΠΎΠ»ΠΎΠ³, ΡΠΏΠΎΡΠΎΠ±Π½ΡΠΉ ΡΠ°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΠΎ ΡΠ΅Π³ΡΠ»ΠΈΡΠΎΠ²Π°ΡΡ Π»Π΅ΡΠ΅Π½ΠΈΠ΅
Cardiorenal relationships in patients with type 2 diabetes mellitus: new data of the ADVANCE study
Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΈ ADVANCE ΠΏΡΠΎΡΠ»Π΅ΠΆΠΈΠ²Π°Π΅ΡΡΡ ΠΏΠ°ΡΠ°Π»Π»Π΅Π»ΡΠ½ΠΎΠ΅ Π½Π°ΡΠ°ΡΡΠ°Π½ΠΈΠ΅ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ ΡΠ΅Π½ΠΎΠΏΡΠΎΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΊΡΠ° ΠΈ ΠΏΡΠ΅Π΄ΡΠΏΡΠ΅ΠΆΠ΄Π΅Π½ΠΈΡ ΠΎΠ±ΡΠ΅ΠΉ ΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ, ΡΡΠΎ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π°Π΅Ρ Π³ΠΈΠΏΠΎΡΠ΅Π·Ρ ΠΎ Π²Π·Π°ΠΈΠΌΠΎΡΠ²ΡΠ·ΠΈ ΠΌΠ°ΡΠΊΠ΅ΡΠΎΠ² ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ADVANCE ΡΠ±Π΅Π΄ΠΈΡΠ΅Π»ΡΠ½ΠΎ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΡΠ΅Ρ, ΡΡΠΎ Π΄Π°ΠΆΠ΅ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Π‘Π2 ΡΡΠ°ΡΡΠ΅ 60 Π»Π΅Ρ Ρ Π²ΡΡΠΎΠΊΠΈΠΌ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΡΠΌ ΡΠΈΡΠΊΠΎΠΌ ΠΈ Π΄Π»ΠΈΡΠ΅Π»ΡΠ½ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ Π½Π°Π·Π½Π°ΡΠ΅Π½ΠΈΠΈ Π² ΡΡΡΠΈΠ½Π½ΠΎΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠ΅ ΡΠ°ΠΊΠΈΡ
ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΎΠ² ΠΊΠ°ΠΊ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠ½?ΠΠ ΠΈ Π½ΠΎΠ»ΠΈΠΏΡΠ΅Π» ΡΠΎΡΡΠ΅ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ½ΠΎ ΠΈ Π²ΡΡΠΎΠΊΠΎΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ, ΠΏΠΎΡΠΊΠΎΠ»ΡΠΊΡ ΠΏΠΎΠ·Π²ΠΎΠ»ΡΠ΅Ρ ΡΠ½ΠΈΠ·ΠΈΡΡ ΡΠΈΡΠΊ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΠΊΠ°ΡΠ΄ΠΈΠΎΡΠ΅Π½Π°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° ΠΈ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎ-ΡΠΎΡΡΠ΄ΠΈΡΡΠΎΠΉ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΠΈ
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