Gliclazide MR in the structure of antihyperglycemic therapy according to the data of Moscow region diabetes register

Background: Sulfonylureas (SU) are often used for second and third line type 2 diabetes mellitus (T2DM) therapy. Currently, there are no unified recommendations governing the choice of drugs for the second line therapy. This requires clarification.Aim: To examine Moscow Region DM register data for assessing ongoing antihyperglycemic therapy and its correspondence to current local and international T2DM treatment recommendations, as well as actual clinical recommendations for the treatment of T2DM patients and COVID-19.Materials and methods: The structure of glucose-lowering therapy with non-insulin drugs (NID) was studied in T2DM patients according to the data T2DM register of Moscow region. The analysis was carried out on 06.02.2021. We analyzed the general group of T2DM patients (237479 people), group 60 years and older (188644 patients), T2DM patients who have had COVID-19. Newly diagnosed T2DM individuals were analyzed for 2020 (5088 people).Results: Glucose-lowering therapy is received by 97.6% of T2DM patients. Of these, 79.07% take NID, insulin + NID - 11.37%. Monotherapy is received by 44.4% of patients, a combination of two drugs - 29.3%, out of three - 5.3% of patients. Metformin is the leader in prescribing NID (69.4% of all T2DM patients and 81.3% in newly diagnosed patients). SU are in second place in T2DM treatment (50% of all patients, 24.1% in newly diagnosed patients), iIDPP-4 is in third place (12.1% and 12.6%, respectively). Among patients of 60 and more years old, 25.99% of patients take gliclazide MR, 14.3% glibenclamide, 7.7% glimepiride. Mortality from COVID-19 depends on the diabetes duration.Conclusion: According to the DM register, half of the T2DM patients and a quarter of T2DM newly diagnosed patients get SU. As a first-line drug, SU is on the second place after metformin and are most often used in double and triple combinations of T2DM therapy. In the older age group on SU, preference is given to gliclazide MR

The role of proper insulin injection technique training FOR achieving of good glycaemic control

Inappropriate injection technique leads to incorrect insulin dosing, increased pain and impaired glucose control in patients with diabetes. This review examines in detail the results of two clinical studies, the Glycemic Impact of Insulin Injection Technique (GIIIT) and the UK Lipo Study (UKLS) that examined the effect of teaching patients proper injection techniques to achieve good glycemic control. The GIIIT study included patients with type 1 and type 2 diabetes (1870 years) who were on a regimen of multiple daily insulin injections. They were categorised into three groups: those that received structured injection technique training using 4-mm injection needles (TN), those that received injection technique training (T) and control (C). The UKLS study included 75 patients who received structured training to reduce the risk of developing lipohypertrophy. Initially, deviations from proper insulin injection technique were observed in a majority of patients in both the studies. In the GIIIT study, 6 months after training under TN and T conditions, HbA1c decreased by 1%, with no observable changes under the C condition. The daily insulin dose was increased by 6 IU in all conditions. Overall, the use of 4-mm short needles reduced post-injective pain in all patients. In the UKLS study, for 6 months, the variability of glycemia and frequency of unexplained hypoglycaemia decreased as the daily dose of insulin decreased by an average 6 IU; in addition, HbA1c level decreased from 8.6% to 8.2%. Six months after the training, both studies noted a decrease in or disappearance of lipohypertrophy in the patients. These results indicate that proper injection technique training improves glycemic control in patients with diabetes

АППРОКСИМАЦИЯ ЛУЗИНА ФУНКЦИЙ ИЗ КЛАССОВ СОБОЛЕВА НА УЛЬТРАМЕТРИЧЕСКИХ ПРОСТРАНСТВАХ С УСЛОВИЕМ УДВОЕНИЯ

In this article, we consider an analog of the Luzin theorem on the correction for Sobolev-type spaces on ultrametric spaces with a doubling condition. The correcting function belongs to the Hölder class and approximates a given function in the metrics of the initial space. Dimensions of exceptional sets are evaluated in terms of capacities and Hausdorff volumes. This result was previously obtained for the special case of the p-adic vector space.В работе рассматривается аналог теоремы Лузина об исправлении для пространств соболевского типа на ультраметрических пространствах с условием удвоения. Исправляющая функция принадлежит классу Гельдера и приближает заданную функцию в метрике исходного пространства. Размеры исключительных множеств оцениваются в терминах емкостей и вместимостей Хаусдорфа. Этот результат был ранее получен для частного случая пространства p-адических векторов

ХРОНИЧЕСКАЯ ОБСТРУКТИВНАЯ БОЛЕЗНЬ ЛЕГКИХ И ХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ У ПОЖИЛЫХ

The article provides literature review on the subject: chronic obstructive pulmonary disease: pathogenesis, principles of treatment, the course of heart failure in elderly people with comorbide pathology (chronic obstructive pulmonary disease and cardio-vascular diseases). Role of NT-pro BNP as marker of heart failure in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) was analyzed. Influence в-blockers and m-anticholinergic drug on cardiovascular system, and possibility of reception of β-blockers at people with COPD and HF was studied. Представлен обзор литературы о патогенезе, принципах лечения, течении сердечной недостаточности у пожилых людей с коморбидной патологией (хроническая обструктивная болезнь легких (ХОБЛ) и сердечно-сосудистые заболевания). Проанализирована роль NT-proBNP как маркера сердечной недостаточности у больных с хронической сердечной недостаточностью (ХСН) и хронической обструктивной болезнью легких. Рассмотрено влияние бета-агонистов и м-холинолитиков на сердечно-сосудистую систему и возможность приема бета-блокаторов у больных ХОБЛ с ХС

Дифференцированные подходы к выбору срока оперативного лечения туберкулеза внутригрудных лимфатических узлов у детей в период роста туберкулеза с множественной лекарственной устойчивостью

The objective: to develop differentiated approaches to the choice of timing of surgical treatment of intrathoracic lymph node tuberculosis (ITLNTB) in children during the increasing incidence of multiple drug resistant tuberculosis (MDR-TB).Subjects and Methods. 52 patients of 2-12 years old had their intrathoracic lymph nodes removed at different stages of anti-tuberculosis therapy. All children had massive (more than 10-15 mm) conglomerates in their intrathoracic lymph nodes. Additionally to changes in intrathoracic lymph nodes, 12 people had active tuberculous changes in the lungs or bronchial tuberculosis.Results. 5 patients were operated before chemotherapy, 35 patients after 2 months of treatment, and 12 patients underwent surgery afterwards. The elective surgery was performed in 51 children, and 1 child had surgery before the start of chemotherapy due to vital indications (the threat of breakthrough of caseous masses into the trachea).Planned surgical treatment in children with tuberculosis of intrathoracic lymph nodes should be carried out within the following timing: before the start of anti-tuberculosis therapy in the absence of clinical, laboratory and radiological signs of the disease being active; as soon as possible from the start of chemotherapy (it is enough to focus on the results of the first CT control after 2 months of treatment (there should be no tendency to involution of pathological changes) in the presence of minimal signs of tuberculosis activity). The choice of timing of planned surgical treatment is individual and determined by the timing of stabilization of pulmonary changes or the cure of bronchial tuberculosis (after 6, 9, 12 months) in patients with newly diagnosed active tuberculosis of intrathoracic lymph nodes in combination with lung and/or bronchial lesions. The development of life-threatening complications is an absolute indication for emergency surgery.Цель исследования: разработать дифференцированные подходы к выбору сроков оперативного лечения туберкулеза внутригрудных лимфатических узлов (ВГЛУ) у детей в период роста туберкулеза с множественной лекарственной устойчивостью (ТБ-МЛУ).Методы и материалы. На разных сроках противотуберкулезной терапии проведено удаление ВГЛУ 52 пациентам в возрасте 2-12 лет. У всех детей наблюдались массивные (более 10-15 мм) конгломераты ВГЛУ. У 12 чел., помимо изменений во ВГЛУ, отмечались активные туберкулезные изменения в легких или туберкулез бронхов.Результаты. Прооперированы до начала химиотерапии 5 чел., через 2 мес. лечения – 35 чел., в более поздние сроки – 12 чел. В плановом порядке операции выполнены у 51 ребенка, по жизненным показаниям (угроза прорыва казеозных масс в трахею) до начала химиотерапии ‒ у 1 ребенка.Плановое оперативное лечение у детей с туберкулезом ВГЛУ должно проводиться: до начала противотуберкулезной терапии при отсутствии клинико-лабораторных и рентгенологических признаков активности процесса; в максимально короткие сроки от начала химиотерапии (достаточно ориентироваться на результаты первого КТ-контроля через 2 мес. лечения (нет тенденции к инволюции патологических изменений) при наличии минимальных признаков активности туберкулеза). Выбор сроков планового оперативного лечения индивидуален и определяется сроками стабилизации легочного процесса или излечения туберкулеза бронхов (через 6, 9, 12 мес.) у пациентов с впервые выявленным активным туберкулезом ВГЛУ в сочетании с поражением легких и/или бронхов. Развитие жизнеугрожающих осложнений – абсолютное показание для экстренного оперативного вмешательства

The role of sodium-glucose cotransporter 2 inhibitors in the treatment of type 2 diabetes: from clinical research to real practice

In type 2 diabetes mellitus (T2DM), the development and progression of cardiovascular diseases occurs, which allows it to be considered as a cardiorenal metabolic syndrome. This should be taken into account when choosing hypoglycemic drugs. Patients with T2DM receiving insulin therapy often have a long history of diabetes, cardiovascular disease, chronic kidney disease, obesity, and need to be prescribed high doses of insulin and/or complex insulin therapy regimens to maintain glycemic control, which does not always lead to the achievement of target levels of glycemia and glycated hemoglobin (HbA1c). Adding to any insulin therapy regimen drugs from the class of sodium-glucose cotransporter type 2 inhibitors (SGLT-2), which have proven their cardio- and renoprotective properties, seems to be a rational combination in patients with T2DM and may have a number of advantages. The article presents 4 clinical examples of dapagliflozin administration, a drug from the SGLT2 class, to patients who are on insulin therapy, having T2DM with a  long history (10–26 years), as well as cardiovascular diseases, chronic kidney disease, and obesity. Dapagliflozin administration allowed to improve glycemic control, to stabilize the insulin dose, as well as reduce body weight without increasing the frequency of serious episodes of hypoglycemia in patients who initially received large doses of insulin. In the long term, we can expect reduction of the progression of cardiovascular risks and the risks of hospitalization due to existing complications of the disease

THE EPIDEMIOLOGICAL SITUATION ON DIABETES MELLITUS IN THE MOSCOW REGION IN THE YEARS 2004-2013

Background: It is extremely important to have information about the main epidemiological indicators characterizing the situation on diabetes mellitus (DM) in Moscow Region. Aim: To assess the dynamics of the main epidemiological indicators of type 1 DM (T1DM) and type 2 DM (T2DM) for the 10-year period (2004-2013). Materials and methods: The study was performed based on the analysis of data of the Moscow Region DM Register, which contained information about 202 909 patients with DM. The indicators are presented per 100 000 of the population. Results: The T1DM prevalence increased from 132.09 to 166.6 per 100 000 within a decade fixed, and that of DM2 – from  2121.9  to 3263.12. The T2DM incidence increased from 193.22 to 224.4. T1DM mortality decreased from 0.9 to 0.6 per 100 000, and in patients with DM2 – from 68.3 to 61.4. The average life expectancy in adult patients with T1DM increased by 1.3 years, in patients with T2DM – by 1.7 years. Conclusion: It was found that the registered prevalence of both T2DM (35%) and T1DM (by 20.5%) increased within the 10-year period. Increase of T2DM incidence was noted in individuals under 40 years of age, and the average peak of T1DM morbidity shifted from the age group of 10-14 years to the 7-9-year group. Cardiovascular diseases are still the prevailing cause of death in T2DM patients (60%). In T1DM patients, the main cause of death was chronic renal failure if onset of the disease occurred in patients under 25, and macrovascular complications – if the first disease manifestation was noted in patients above 25

Questionnaire-assessed risk of sleep apnea in inpatients with various endocrine disorders

Background: Sleep breathing disorders can be an additional risk factor for the development of cardiovascular disorders in patients with endocrine disorders.Aim: To assess the sleep apnea risk in patients with various endocrine disorders undergoing inpatient treatment.Materials and methods: The sleep apnea risk and the severity of daytime sleepiness were evaluated in 282 inpatients with endocrine disorders based on the following questionnaires: the Epworth Sleepiness Scale (ESS), the sleep apnea screening questionnaire (SAS), and the Berlin sleep apnea risk questionnaire (BQ). To identify the real prevalence of sleep respiratory disorders in endocrine patients we performed cardio-respiratory monitoring with Watch-PAT200 (“Itamar Medical”, Israel) device in 81 patients.Results: A high sleep apnea risk according to the BQ was detected in 59.9% (160/267) of the patients, according to the SAS in 53.53% (144/269), excessive daytime sleepiness (≥ 11 points) was found in 21.66% (60/277) of the patients with the ESS. Among the patients undergoing cardiorespiratory monitoring, sleep apnea was detected in 84% (68/81), including severe apnea in 38.2% (26/68). The highest sleep apnea risk by BQ and SAS was observed in the patients with type 2 diabetes, acromegaly and hypercortisolism. Excessive daytime sleepiness by the ESS was most noticeable in those with hypercortisolism and thyrotoxicosis.Conclusion: The high risk of sleep apnea in the inpatients with type 2 diabetes mellitus, acromegaly, hypercorticism, and hypothyroidism makes it necessary to include its active screening into the algorithm of their inpatient assessment to rule out any sleep breathing disorder