cover letter

Recently, the bihormonal theory of the autoimmune diabetes development is discussed in the world literature. The abnormal suppression of glucagon and reduced incretin response are considered in the development and progression of type 1 diabetes mellitus in addition to insulin deficiency. Animal studies demonstrate a GLP-1 – role in beta cell-proliferation and decrease in apoptosis. The information concerning the functioning of the incretin system in patients with type 1 diabetes and LADA is systematized in the present review. We also discuss the studies of the use of GLP-1 agonists in patients with autoimmune diabetes

Autoimmune gastritis: comorbid pathology in type 1 diabetes

In recent years noted an increased number of patients with autoimmune diseases (AID), and the special attention deserves combination of several autoimmune pathologies collected in one patient, because such patients requires special tactics of management. Autoimmune diseases of the gastrointestinal tract are less researched and, nevertheless, prognostically unfavorable. Autoimmune gastritis (AIG) has a special place in other stomach diseases, which develops in the aggregate with type 1 diabetes. AIG is a chronic inflammation of the mucous membrane of the body of the stomach, leading to the appearance of atrophy and hypoxecretion. AIG is found in 510% of individuals in general population, with a higher incidence of AIG in patients with diabetes and other established autoimmune pathology. AIG is asymptomatic at the early stage of the disease and clinical manifestations appear after the atrophic changes in the mucous membrane of the stomach develop. Since autoimmune gastritis does not have pathognomonic signs, it can manifest itself in hematological and oncological complications at later stages. This is why screening, early diagnosis, prevention and treatment are very important. Early diagnosis and prevention of AIG and its complications play the main role. This article provides an overview of the worldwide data dedicated to this issue

Diabetes mellitus type 1 in adults

Public organization “Russian Association of Endocrinologists”. Clinical guidlines

Diabetes mellitus type 2 in adults

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

Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition

Dear Colleagues! We are glad to present the 9th Edition (revised) of Standards of 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), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). 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, 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 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 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 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) – Type 2 DM, 6% (256 202) – Type 1 DM and 2% (89 870) – other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they don’t receive any treatment ant have high risk of vascular complications. Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary 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 the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given. Added a snippet that describes the continuous glucose monitoring. Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism. Proposes more stringent target levels of blood pressure. It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion. 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. Recommendations for psychosocial support are added. The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated. Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added. For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation. This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM. On behalf of the Working Grou

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

Incretins role in Latent autoimmune diabetes of adults pathogenesis, the possibility of therapy with combination of glucagon-like peptide-1 agonist (GLP-1) and insulin.

Recently, the bihormonal theory of the autoimmune diabetes development is discussed in the world literature. The abnormal suppression of glucagon and reduced incretin response are considered in the development and progression of type 1 diabetes mellitus in addition to insulin deficiency. Animal studies demonstrate a GLP-1 – role in beta cell-proliferation and decrease in apoptosis. The information concerning the functioning of the incretin system in patients with type 1 diabetes and LADA is systematized in the present review. We also discuss the studies of the use of GLP-1 agonists in patients with autoimmune diabetes

Association of polymorphism rs7903146 gene TCF7L2 with low concentrations of autoantibodies in latent autoimmune diabetes of adults (LADA)

Aim. To determine the frequencies of alleles and genotypes of polymorphic marker rs7903146 of the TCF7L2 gene in latent autoimmune diabetes in adults (LADA) and healthy individuals. The aims of the study were also to compare the distribution of alleles and genotypes and to explore the association with the development of LADA. Materials and methods. A total of 96 patients (46 females and 50 males) with LADA and 201 healthy individuals were examined. A quantitative determination of autoantibodies GADA, ICA, IA-2A and ZnT8 in the serum of LADA patients was performed. All patients underwent genotyping of rs7903146 of the TCF7L2 genes. Results. There was an increased frequency of the T allele and genotype T+ of marker rs7903146 of the TCF7L2 gene in patients with LADA with low concentrations of autoantibodies compared to a group of patients with high concentrations and with controls. We observed significant associations of the T allele and genotype T+ with LADA in patients with low concentrations of autoantibodies [p = 0.02; odds ratio (OR) = 1.85; 95% confidence interval (CI) = 1.10–3.13 and p = 0.04; OR = 2.14; 95% CI = 1.01–4.53 for the T allele and genotype T+, respectively). Conclusion. The results of the study suggest that LADA patients with low concentrations of autoantibodies have a genetically pre-determined similarity with patients with type 2 diabetes

Prognozirovanie SD 1 tipa v gruppakh vysokogo riska

Актуальность Предрасположенность к СД 1 типа генетически детерминирована. Заболеваемость СД 1 типа контролируется рядом генов. Наибольшее значение из известных генетических маркеров СД 1 типа имеют гены области HLA на хромосоме 6р 21.3. Наибольшее значение из известных типов аутоантител, являющихся иммунологическими маркерами СД 1 типа, имеют антитела к глутаматдекарбоксилазе (ГДК) и цитоплазме островковых клеток (АЦОК). Цель работы Формирование групп высокого риска развития СД 1 типа в русской популяции жителей Москвы на основе изучения генетических, иммунологических и метабо?лических маркеров диабета с использованием семейного подхода. Материалы и методы Обследовано 26 семей, в которых один из родителей болен СД 1 типа, из них 5 - "ядерных" семей (всего 101 человек). Определялись аутоантитела к бета-клеткам (ICA), аутоантитела к инсулину (IAA), антитела к ГДК, С-пептид. HLA-типирование больных СД и членов их семей выполнялось по трем генам: DRB1, DQA1 и DQB1. Результаты Установлено, что в 26 семьях из 26 больных СД 1 типа родителей 23 человека (88,5%) являются носителями ассоциированных с СД 1 типа HLA-генотипов DRB1 *03-DQAl *0501-DQB1 *0201; DRB1 *04-DQAl *0301-DQB 1*0302 или их сочетаний. При генотипировании прямых потомков пациен-тов с СД 1 типа выявлено, что из 37 человек 30 (81%) унаследовали ассоциированные с СД 1 типа генотипы DRB1*03, DRB 1*04 и их сочетание, у 3 лиц в генотипе присутствуют ассоциированные с СД 1 типа аллели: у 1 - DQA 1*0501, у 2 пациентов - DQB 1*0201. Всего 4 из 37 обследованных имеют нейтральный генотип по отношению к СД 1 типа. Выводы Больные СД 1 типа в 88,5% случаев являются носителями генотипов DRB1*03, DQA1*0501, DQB1*0201, DRB1*04, DQA1*0301, DQB1*0302, или их сочетаний. У детей из семей, где один из родителей болен СД 1 типа, в 89% случаев выявляется генетическая предрасположенность к СД. Среди прямых потомков больных СД 1 типа, имеющих генетическую предрасположенность, положительные антитела к ГДК выявлены в 8% случаев, АЦОК - в 5,4% случаев