Course and treatment of diabetes mellitus in the context of COVID-19

In 2020, the world is facing a historically unparalleled public health challenge associated with the invasion of the new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This is also a challenge for the healthcare systems worldwide. Patients with diabetes mellitus (DM) are most vulnerable to COVID-19 because of the peculiarities of their immune response to a virus attack and due to their high susceptibility to viral activity because of hyperglycemia and other comorbid conditions and obesity that often accompany DM. The severity of the COVID-19 disease requires a mandatory review of the usual anti-hyperglycemic therapy. Maintaining optimal glycemic control and preventing the development of ketoacidosis remain extremely important; therefore, insulin becomes the priority drug for glycemic control in most cases. The search for new drugs to fight against the coronavirus infection continues with new randomised clinical drug trials being launched. Innovative anti-diabetic agents are also being tested as candidates for potentially effective anti-coronavirus agents

Features of the eye pathology in primary hyperparathyroidism

The pathology of vision occurs in various endocrine diseases, but information about the state of the eyes in patients with primary hyperparathyroidism (PHPT) has been limited yet. Large systematic studies on this problem are absent, mainly the data of foreign literature are based on descriptions of several clinical cases that report about non-specific changes of eyes in people with significant hypercalcemia. The most common manifestations of hyperparathyroid ophthalmopathy are the cornea and conjunctiva calcification, disfunction of the eye muscles. Taking into account the prevalence of mild PHPT caused by early diagnosis and timely pathogenetic treatment of the disease, nowadays these ophthalmic disorders are rare. However, specific eye pathology in this category of patients requires detailed study and further research

Primary hyperparathyroidism in combination with metabolic syndrome and sleep apnea

This paper presents a case of primary hyperparathyroidism with a broad spectrum of metabolic disturbances and concomitant sleep apnea syndrome. As shown a timely surgical treatment helps to improve the mineral parameters and alleviate the risk of possible cardiovascular complications in future. The article is the RePrint from the original publication in Obesity and Metabolism (2014) 11(3); pp. 51-55. doi: 10.14341/omet2014351-5

The first experience of a hybrid approach in the surgical treatment of atrial fibrillation

Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results

Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 10th edition

Dear Colleagues!We are glad to present the 10th Edition (revised) of the Standards of Specialized Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), European Association for the Study of Diabetes (EASD 2018, 2019), American Diabetes Association (ADA, 2018, 2019, 2021), American Association of Clinical Endocrinologists (AACE, 2020, 2021), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2018) and Russian Association of Endocrinologists (RAE, 2019). Current edition of the “Standards” also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, CREDENCE, CAROLINA, DAPA-CKD, DAPA-HF, EMPEROR-Reduced trial, VERIFY, VERTIS CV, PIONEER, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 537 million patients by the end of 2021. According to the current estimation by the International Diabetes Federation, 643 million patients will be suffering from DM by 2030 and 784 million by 2045.Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 871 863 patients with DM in this country on 01.01.2021 (3,34% of population) with 92,3% (4 498 826)–Type 2 DM, 5,6% (271 468)–Type 1 DM and 2,1% (101 569)–other types of DM, including 9 729 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) confirmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 10 million patients (about 7% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment and have high risk of vascular complications.Severe consequences of the global pandemic of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.In сurrent edition of the “Standards”:New goals of glycemic control for continuous glucose monitoring (time in range, below range and above range, glucose variability) are given.It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes.In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages.Indications for the use of antidiabetic agents in chronic kidney disease are expanded.Information about insulin pump therapy is added.Recommendations on vaccination are added.An algorithm for replacing some insulin preparations with others is given.This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discussions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians, pediatricians and other medical professionals involved in the treatment of DM.Compared with previous edition of the Standards of Specialized Diabetes Care edited by Dedov I.I., Shestakova M.V., ­Mayorov A.Yu., 10th edition, Moscow, 2021 (signed for printing on 10.09.2021) a number of changes have been made.On behalf of the Working Grou

Ethnic differences in risk factors and prevalence of type 2 diabetes in the adult population of the Russian Federation (a sub-analysis of the NATION study)

A retrospective analysis of the database of the NATION nation-wide epidemiological cross-sectional study was carried out. Depending on the self-declared ethnicity and anthropological characteristics, the following ethnic groups were identified: “Mongoloid population”, “Peoples of the Volga region”, “Peoples of the North Caucasus”, “Peoples of Transcaucasia”, “Russians”. The analysis consisted of several stages and included: analysis of the selected groups’ anthropometrics, analysis of the prevalence of carbohydrate metabolism disorders in the selected ethnic groups, analysis of ethnic-specific T2D risk factors, and analysis of region-specific factors affecting the prevalence of carbohydrate metabolism disorders in various ethnic groups. We defined carbohydrate metabolism disorders as diabetes and/or a prediabetes condition. In accordance with the WHO criteria, HbA1c≥6.5% was interpreted as diabetes, whereas values ​​in the range of 5.7%≤HbA1c<6.5% as prediabetes.RESULTS: The highest prevalence of carbohydrate metabolism disorders was observed among the “Peoples of the Volga region” group (31.2%), the lowest – among the “Peoples of the North Caucasus” group (15.6%). The “Peoples of the Volga region” group had a significantly lower BMI vs. the “Peoples of the North Caucasus” group. Carbohydrate metabolism disorders occurred more often in patients with abdominal obesity / 1st-stage obesity or aged over 45 among the “Mongoloid population” and the “Peoples of the Volga region” groups vs. the “Peoples of the Northern Caucasus” and the “Peoples of Transcaucasia” groups. Prevalence of carbohydrate metabolism disorders among the “Peoples of the Volga region” group residing in their native lands was higher than among Russians residing in the same regions: 32.5% vs. 24.3% (p<0.001 χ2 test) and also higher than among Russians residing in the Central Federal District: 32.5% vs. 27.4%, respectively (p=0.001, χ2 test). Prevalence of carbohydrate metabolism disorders among the “Peoples of the North Caucasus” group was lower than among the “Russians” group: 13.9% vs. 27.36%, respectively (p<0.001, χ2 test). Prevalence of carbohydrate metabolism disorders among the “Peoples of the North Caucasus” group living in their native lands (n=598) was lower than among the same group residing elsewhere in Russia (n=164) (13.9% vs. 21.95%, p=0.012, χ2 test