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

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 glucose-lowering therapy structure in special groups of type 2 diabetes mellitus patients based on data from the Moscow region register

BACKGROUND: Data of real clinical practice in diabetes mellitus (DM) register allow to evaluate features and trends in structure of glucose-lowering therapy (GLT). AIM: Тo analyze of structure of GLT received by patients with type 2 diabetes mellitus (T2DM) in Moscow region for 2018 and to evaluate its dynamics over 15 years. METHODS: Analysis of GLT structure was carried out on basis of data from register of patients with DM in Moscow region, which is part of National register of diabetes mellitus in Russian Federation. In March 2018 it contained data on 211,792 T2DM patients of Moscow region. Structure of GLT administration was evaluated according T2DM duration, patient’s age and presence of cardiovascular diseases (CVD). Dynamics of GLT is analyzed from 2004 to 2018 yrs. RESULTS: In 2018 non-insulin glucose-lowering drugs (NIGD) prescription prevailed (78.3%), insulin therapy was prescribed in 18.5% of patients, 3.2% of patients did not receive drug therapy. Most commonly prescribed NIGD were metformin (69.3%) and sulfonylurea (51.3%). Older patients more often than younger did not use GLT at all and less frequently received insulin therapy and iDPP-4. Insulin therapy was prescribed twice as often in patients with CVD compared with patients without CVD (29.6% and 15.5%). NIGD monotherapy has been less commonly used in patients with CVD (67.3% and 81.2%). Glucagon-like peptide-1 receptor agonists (GLP-1 RA) were prescribed to patients with CVD GLP-1 RA – in 0.1% of cases, without CVD in 0.3% of cases, and sodium-glucose cotransporter 2 (SGLT2) inhibitors in 1.1% and 0.6%. correspondently. CONCLUSION: Metformin was most commonly prescribed drug in GLT structure for T2DM patients in the Moscow region in 2018 yr. Percentage of new drugs in the structure of GLT increased mainly due to iDPP-4, and secondly due to SGLT2 inhibitors. New classes of GLT were more often prescribed to patients of younger age, with diabetes duration up to 10 years, overweight or obese. Administration of NIGD with proven cardiovascular protection in presence of CVD is almost two times less than for those without CVD

Глобализация как фактор развития программных принципов международной организации труда

Проаналізовано передумови, програмні засади та напрями забезпечення справедливої глобалізації як основи міжнародного врегулювання сучасних соціально-трудових відносин. Визначено роль концепції гідної праці у напрямах сприяння справедливій глобалізації. Доведено, що програмна та нормотворча діяльність МОП якраз і спрямована на вирішення двоєдиного стратегічного завдання: використання потужного глобалізаційного ресурсу та додаткового захисту людини праці.Preconditions, program principles and directions of providing a fair globalization as the modern international regulation basis of social and labor relations was analyzed. The role of decent work in the areas of promoting fair globalization is determined. The clarification and development of international labor standards and the international law implementation into the national labor law and their application in the labor protection activities become particularly important issues in the modern conditions of globalization. Improved that social dimension of globalization is directly related to the interests of the general public, where the fore the issue of safety, health and education. Program and standard-setting activities of the ILO in such circumstances is precisely aimed at addressing the dual strategic objectives: the use of powerful globalization resource and additional protection of working people. The most important areas to ensure fair globalization include: converting decent work a global goal; ILO support coherent national policy to ensure fair globalization; promotion of decent work in global production systems; strengthening the system of international labor standards.Проанализированы предпосылки, программные принципы и направления обеспечения справедливой глобализации как основы международного урегулирования современных социально-трудовых отношений. Определена роль концепции достойного труда в направлениях содействия справедливой глобализации. Доказано, что программная и нормотворческая деятельность МОТ как раз и направлена на решение двуединой стратегической задачи: использование мощного глобализационного ресурса и дополнительной защиты человека труда

Comparative study of minimally invasive and traditional approaches for the microsurgical treatment of circle of Willis unruptured intracranial aneurysms

Objective. The study objective was to compare the effects of minimally invasive and traditional surgical approaches for treating patients with unruptured intracranial aneurysms (UIAs) to assess efficacy and safety of the keyhole concept in neurosurgery.Material and Methods. We conducted a comparative analysis of the microsurgical treatment outcomes of 204 patients harbouring UIAs who were operated on from 2014 to 2019. Patients were divided into two groups: operated on using traditional approach (n = 85, 41.7%) and minimally invasive approach (n = 119, 58.3%). Patients of the first group were operated on using pterional (n = 31), orbitozygomatic (n = 16) and lateral supraorbital (n = 38) approaches; in the second group, patients underwent surgery using trans-eyebrow supraorbital (n = 35), minimal pterional (n = 38), trans-eyebrow transorbital (n = 20) and transpalpebral transorbital (n = 26) approaches. Rate of intraoperative and postoperative complications, surgery duration and postoperative in-hospital stay period were the factors to compare. The Modified Rankin Scale was used as a neurological outcomes measure. Also cosmetic results of surgery, hypesthesia from the site of the surgical approach, temporomandibular joint disorder and facial asymmetry were evaluated.Results. Compared to the traditional approach, minimally invasive technique incurred shorter surgery duration (р = 0.051) and inpatient stay (р > 0.001). Intraoperative and postoperative complication rates (р > 0.05) as well as functional outcomes (р > 0.05) were comparable between the two groups, while cosmetic effects (р < 0.05) were greater in minimally invasive group of UIA patients.Conclusion. Microsurgical treatment of UIA patients using minimally invasive approach is considered safe and effective. Adequate selection of patients for operation and exhaustive neuroimaging data assessment for choosing of neurosurgical technique are obligatory factors for keyhole surgery. The authors recommend using minimally invasive concept only for experienced neurosurgical teams in specialized clinics

EXPERIMENTAL SUBSTANTIATION OF APPLICATION GEL IMPLANT «SFERO®GEL» AND FILM IMPLANT «ELASTOPOB»® AT A TRAUMA OF PERIPHERAL NERVOUS SYSTEM IN EXPERIMENT

The purpose of the present work was the experimental substantiation of application of new biodegraded materials: gel implant «Sfero®Gel» and a film membrane of «ElastoPOB»® a domestic production, in surgery of defeats of peripheral nerves. Experimental researches carried out on females of nonlinear rats, is powerful 200–250 gramme. In experience 10 animals are used, 20 operative interventions on sciatic nerves are executed. Morphological studying of the received material in 101 days after operation was carried out. At application of a membrane «ElastoPOB»® it was defined delimitin of peripheral nerves from surrounding tissue. A film membrane of «ElastoPOB»® is perspective to apply at traumas of a nervous fabric for the purpose of formation of a friable hem in a damage zone. On the basis of the received experimental data it is possible to make the conclusion about possibility and expediency of application of biodegraded materials in surgical treatment of defeats of peripheral nervous system

Оценка организации медицинской помощи и лекарственного обеспечения при ревматических заболеваниях и социально-экономического бремени этих болезней в Российской Федерации

This article reviews data on the assessment of the incidence of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA, arthropathic psoriasis), as well as related disability and the economic burden of these nosological entities, including their therapy with biological agents. It considers the issues of organization and quality of medical care, drug supply, normative and legal regulation. The paper also shows the important epidemiological and socioeconomic importance of RA, AS, and PsA in Russia, points out the regional peculiarities of medical care and drug provision, and proposes solutions for their optimization at the federal and local levels. In preparing this investigation, the authors have taken into account the opinions of many specialists and experts in this field from different subjects of the Russian Federation.Представлен обзор данных, касающихся оценки заболеваемости ревматоидным артритом (РА), анкилозирующим спондилитом (АС) и псориатическим артритом (ПсА, артропатический псориаз), а также связанных с этими заболеваниями потери трудоспособности, инвалидизации и экономического бремени, включая терапию генно-инженерными биологическими препаратами (ГИБП). Рассмотрены вопросы организации и качества медицинской помощи, лекарственного обеспечения, нормативно-правового регулирования. Показано важное эпидемиологическое и социально-экономическое значение РА, АС и ПсА в России, отмечены региональные особенности оказания медицинской помощи и лекарственного обеспечения и предложены решения для их оптимизации на федеральном и местном уровнях. При подготовке исследования были учтены мнения многих специалистов и экспертов в данной области из различных субъектов Российской Федерации

Prevalence of diabetes mellitus in patients with acromegaly

Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) are frequently associated with acromegaly. We aimed to assess the prevalence of ECMDs in patients with acromegaly and to compare the results with those in adults without acromegaly using two population-based epidemiologic surveys. We evaluated 97 patients with acromegaly in several phases of their disease (mean age, 56 years and estimated duration of acromegaly, 12.5 years). An oral glucose tolerance test was done in those not yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucose tolerance+impaired fasting glucose). Comparisons were made between patients with acromegaly and participants from the general adult population (n=435) and an adult population with multiple type 2 diabetes risk factors (n=314), matched for gender, age and BMI. DM was diagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population (P<0.001). The prevalence of ECMDs was also higher in patients with acromegaly than in the general population and in the high-risk group; only 22% of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosed ECMDs or DM was 1.3-1.5 times higher in patients with acromegaly compared with the high-risk group. Patients with acromegaly having ECMDs or DM were older, more obese and had longer disease duration and higher IGF1 levels (Z-score). Logistic regression showed that the severity of glucose derangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly, the prevalence of DM and ECMDs considerably exceeds that of the general population and of a high-risk group, and development of DM depends on age, BMI and IGF1 levels

Role of Inflammatory Mediators, Growth Factors, and Osteodystrophy in Recurrent Lumbar Disk Herniation

Introduction. Reintervention in patients with spinal disk herniation is shown to significantly decrease likelihood of favorable outcomes in the postoperative period. Thus, it is important to individually assess risk factors for and likelihood of spinal disk herniation recurrence for each patient, and choose a suitable surgical option. Objective: to evaluate changes in the levels of immunoregulatory mediators in the blood serum and extracted spinal disc tissue of allegedly healthy individuals and patients with lumbar disk herniation relapses. Materials and methods. We examined 60 patients. The control group included 19 patients with traumatic spinal cord injuries at the lumbar level. The main group included 41 patients with spinal disk herniation. Twenty-two individuals had primary herniation while 11 patients presented with single clinical and neurological relapses at the pre-operated lumbar level and 8 patients presented with recurrent relapses. Solid-phase enzyme immunoassay detected proinflammatory cytokines (interleukin-6, tumor necrosis factor-), chemokines (interleukin-8, monocyte chemoattractant protein-1), growth factors (vascular endothelial growth factor, transforming growth factor-1), and osteodestruction markers (osteoprogesterin, matrix metalloproteinase-8) in the blood serum and the extracted spinal disc tissue. Results. We found that spinal disk destruction and chronic inflammation developed with both locally and generally elevating levels of proinflammatory cytokines/chemokines, growth factors, and matrix metalloproteinase 8. Conclusion. The results emphasize the significance of local changes in the studied parameters to choose and plan personalized surgical treatment in patients with spinal disk herniation

Медико-экономический анализ влияния инвалидизации, ассоциированной с ревматическими заболеваниями, на экономику страны с учетом реализации пенсионной реформы

The paper presents the data of an original study evaluating the impact of disability associated with a number of rheumatic diseases (RDs) (rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) on the country's economy, as well as their related losses of the state under the conditions of implementation of the upcoming pension reform (PR). The authors consider the socioeconomic importance of disability associated with RDs in the current period and after PR implementation in 2019–2028, determine the degree of its influence on the country's gross domestic product, and also calculate the economic efficiency of return of the potentially able-bodied proportion of disabled people (able-bodied population) to socioeconomic activity.The opinions of experts and leading experts in this area from different subjects of the Russian Federation were taken into account when preparing the study.В статье представлены данные оригинального исследования, посвященного оценке влияния инвалидизации, ассоциированной с рядом ревматических заболеваний – РЗ (ревматоидный артрит, анкилозирующий спондилит и псориатический артрит), на экономику страны, а также связанных с ними потерь государства в условиях реализации предстоящей пенсионной реформы (ПР). Рассмотрено социально-экономическое значение инвалидизации, ассоциированной с РЗ, в текущем периоде и после проведения ПР 2019–2028 гг., определена степень ее влияния на валовой внутренний продукт страны, а также рассчитана экономическая эффективность возврата потенциально трудоспособной части инвалидов (лиц, находящихся в трудоспособном возрасте) к социально-экономической активности. При подготовке исследования были учтены мнения экспертов и ведущих специалистов в данной области из различных субъектов Российской Федерации