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

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

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

CASE OF SUBCLINICAL COURSE OF TUBERCULOSIS WITH MULTIPLE LOCALIZATION IN 7 YEAR OLD CHILD

The article describes the rare case of concurrent pulmonary and abdominal tuberculosis with multiple drug resistance with formation of numerous tuberculomas in the immune competent 7 year old child vaccinated with BCG. The diagnostics was di¾cult due to the lack of information on exposure to tuberculosis, normergic sensitivity to tuberculin in Mantoux test with 2 TU PPL-L, negative diaskintest result and absence of pathologic changes in the chest lymph nodes. The di|erential diagnostics with parasitic and oncologic diseases was conducted. Diagnosis of tuberculosis was verified morphologically. The treatment tactics included anti-tuberculosis chemotherapy and staged surgical interventions in the lungs and abdomen

Incidence of sleep apnea in patients with various types of glycemic disturbances

Aims. To assess the risk for sleep apnea in patients with various types of glycemic disorders by means of Epworth Sleepiness Scale andSleep Apnea Screening Questionnaire. Materials and Methods. We examined 744 residents of Mozhaisk Region, that were considered to have high risk for development of type2 diabetes mellitus (T2DM), as estimated by FINDRISK Questionnaire. Patients, who scored 12+ were cleared for participation in this study. Combined score from Epworth Sleepiness Scale and Sleep Apnea Screening Questionnaire was applied for diagnosis of sleep apnea, supplemented with specific questions about snoring and episodes of apnea. Glycemic disorders were diagnosed with standard glucose tolerance test. Results. 42.7% of examined patients (n=318) were diagnosed with various types of glucose disorders. Prevalence of abdominal obe- sity (according to waist circumference measurement) comprised 59.3% in male patients and 54.1% in females. We observed positive correlation between body mass index (BMI) and snoring ? 0.3 (p=0.0001), BMI and apnea ? 0.2 (p=0.0001), BMI and daytime sleepiness ? 0.1 (p=0.007); we also observed direct correlation between age and snoring ? 0.2 (p=0.0001), as well as age and sleep apnea ? 0.1 (p=0.028). Risk for sleep apnea was found to be 4.7 times higher in patients with arterial hypertension. After adjustment71Диагностика, контроль и лечениеСахарный диабет. 2013;(1):71?77Сахар ный диабетfor age risk of apnea remained 2.8 times higher in patients with T2DM, 1.9 times higher in subjects with impaired glucose tolerance and1.6 times higher in subjects with impaired fasting glycaemia. Relative risk for snoring in patients with various types of glycemic disorders was 1.1-1.2 against normoglycemic controls. We estimated that all types of glycemic disorders increase risk for apnea 1.2?1.6 times. Conclusion. Glycemic disorders, body weight excess, obesity and arterial hypertension are risk factors for snoring and sleep apnea. Corresponding patient categories should be screened for sleep apnea by questionnaire survey to identify those in need of further complex examination and treatment