Vol 14, No 1 (2011)

Ivan I. Dedov (on the occasion of his 70th birthday)
Diabetes mellitus. 2011;14(1):6-7
Jubilee greetings
Diabetes mellitus. 2011;14(1):8-11
Interview with professor I.I. Dedov
Diabetes mellitus. 2011;14(1):12-14
Epidemiology of diabetes mellitus and prognosis of its prevalence in the Russian Federation
Suntsov Y.I., Bolotskaya L.L., Maslova O.V., Kazakov I.V.
The prevalence of diabetes mellitus (DM) in this country as well as throughout the globe has reached epidemic proportions. The register of DM patientsand relevant epidemiological studies are important sources of objective information about epidemiological situation with respect to DM morbidity thatmay be used to predict the prevalence of DM and its complications. The results of a 5-year project and subsequent prospective studies suggest a risein the number of diabetic patients in Russia (3,163,300 as of 01.01.2010). It is expected to increase up to 5.81 mln within the next two decades althoughsome of the patients will never be registered. The actual prevalence of DM complications also exceeds the registered one; they are not diagnosedin 40-55% of the patients. Prospective studies revealed an increased number of DM1 patients with the HbA1c level <7.0% among children from 9.7to 15.42% (p?0.005), adolescents from 7.4 to 12.41% (p?0.002), adults from 11.4 to 16.46% (p?0.01); it decreased in adults with DM2 from8.74 to 8.04% (p?0.05). As a result, the overall prevalence of main diabetic complications significantly decreased.
Diabetes mellitus. 2011;14(1):15-19
Genetics of monegenic forms of diabetes mellitus
Kuraeva T.L., Zil'berman L.I., Titovich E.V., Peterkova V.A.
It is universally recognized that autoimmune type 1 diabetes mellitus (DM) is not the only form of this disease in children. Increasingly more children andadolescents present with DM2, MODY, and rarer syndromal forms of DM. The actual prevalence of DM other than DM1 in children and adolescentsis unknown but may be estimated at 10%. Despite rare occurrence of genetic syndromes, they collectively account for almost 5% of DM cases amongchildren. The rapid upgrowth of molecular biology opens up a wide range of possibilities for designating various symptom complexes as nosologically selfconsistentforms. New genetic syndromes associated with DM are annually described. It is important both to adequately identify and treat manifestationsand complications of these syndromes in children and to provide relevant medico-genetic counseling and recommendations to the parents.Key words: non-immune diabetes mellitus, MODY, Wolfram syndrome, neonatal, syndromal forms
Diabetes mellitus. 2011;14(1):20-27
Immunogenetic characteristics of LADA
Nikonova T.V., Apanovich P.V., Pekareva E.V., Gorelysheva V.A., Stepanova S.M., Tishina Y.V., Prokof'ev S.A., Karpukhin A.V.
Latent autoimmune diabetes of adults (LADA) is a variant of autoimmune diabetes mellitus. Its clinical feature not typical for classical DM1 despitethe presence of positive autoantibodies is characterized by the low rate of autoimmune destruction that accounts for the late development of insulindependence. Similar to classical DM1, LADA is associated with the loss of immune tolerance to autoantibodies. However, the quantitative andfunctional activity of Treg as key regulators of the immune response and main agents of immune tolerance remain as poorly known as their relationshipwith characteristics of apoptosis.Aim.
To elucidate qualitative and functional changes at the level of immunity regulation in patients with LADA of different duration and theirrelationships with characteristics of apoptosis, immunological and genetic markers.
Materials and methods.
The study included 64 patients (45 men and 19 women) with LADA and 56 control subjects. The methods included HLAgenotyping, detection of autoantibodies against GAD, insulin, tyrosine phosphatase, islet cell antigens, composition of CD3+, CD4+, CD38+, HLADR+, CD25+, CD+25+, CD95, CD95L lymphocyte subpopulations, FoxP3 and C-peptide expression, HbA1c levels.
FoxP3 expression at the onset of LADA was similar to that in control subjects while the relative amount of CD425+high T-lymphocytes increased.In contrast to DM1, FoxP3 expression began to decrease 6-12 months after the onset of LADA when the amount of CD425+high T-lymphocytes loweredto become normal with the progress of the disease. Within 1-5 years after the onset of LADA, FoxP3 expression became normal again but significantlyincreased when its duration exceeded 5 years. Expression of apoptosis markers (CD95 and CD95L) on lymphocytes and of their soluble forms in allLADA patients was comparable with control.
We for the first time determined intensity of FoxP3 expression and the amount of CD425+high T-lymphocytes in patients with differentduration of LADA. FoxP3 expression varies periodically while functional deficit of Treg is delayed and appears to be compensated by a rise in theirnumber. Increased population of Treg within 6 months after the onset of LADA may reflect their regulatory role (suppression of autoimmunity)accounting for the gradual development of the disease.
Diabetes mellitus. 2011;14(1):28-34
Insulin resistance in pathogenesis of type 2 diabetes mellitus
Mayorov A.Y.
This review focuses on the mechanisms of impaired sensitivity to insulin associated withevolution of carbohydrate metabolism disorders from enhanced fasting glycemia (EFG) to impaired glucose tolerance (IGT) and type 2 diabetes.Disturbances of glucose utilization at the receptor and post-receptor levels are considered along with the role of glucose and lipotoxicity. Original dataon insulin resistance (IR) in patients with disorders of carbohydrate metabolism are presented. Insulin sensitivity in DM2, EFG and IGT is shownto be 50, 25 and 15% lower respectively than in normal subjects. M-index positively correlates with BMI and quality of metabolic control (HbA1cand triglyceride levels). The differences in clinical and biochemical characteristics of DM2 patients are analysed depending on the degree of IR.Adiponectin and resistin levels in DM2 are shown to be lower than in healthy subjects while TNF-a and proinsulin levels increase. Therapy withmetformin, pyoglitazone, and insulin improves insulin sensitivity even in patients with early disturbances of carbohydrate metabolism. It is concludedthat intensive hypoglycemic therapy should be initiated before marked deterioration of insulin sensitivity developed.
Diabetes mellitus. 2011;14(1):35-45
Education of diabetic patients: synthesis of evidence-based medicine and psychological approach
Mayorov A.Y., Surkova E.V., Motovilin O.G., Mel'nikova O.G., Shishkova Y.A.
Education of diabetic patients is not only an applied but also a research branch of diabetology. The efficacy of this therapeutic modality must be assessedin accordance with the principles of evidence-based medicine. At the same time, it extends beyond the framework of standard medical actionsand implies the necessity of taking into account the psychosocial context. The main stages of the development of diabetes education at the EndocrinologicalResearch Centre are reviewed including evaluation of the efficacy of structured programs, cooperation with international institutions,and development of new methods. Psychological characteristics of diabetic patients are discussed with reference to taking them into account for thepurpose of education.
Diabetes mellitus. 2011;14(1):46-52
Atrial fibrillation: a new facet of diabetes mellitus in the XXI century
Aleksandrov A.A., Yadrikhinskaya M.N., Kukharenko S.S.
Congestive heart failure, diabetes mellitus, and ciliary arrhythmia are three epidemic cardiovascular conditions threatening the mankind in the XXIcentury. Ciliary arrhythmia is the commonest disturbance of cardiac rhythm characterized by inability of the atrium to maintain coordinated contractions.The importance of ciliary rrhythmia as a problem facing public heath services is underlain by its role as a risk factor of disturbed cerebralcirculation and severe cardiac insufficiency, the two most serious and costly cardiovascular complications influencing life expectancy of the affectedsubjects.
Diabetes mellitus. 2011;14(1):53-60
Interventional cardiology and diabetes mellitus: age of effective coronary heart disease treatment
Kalashnikov V.Y., Bondarenko I.Z., Kuznetsov A.B., Beshlieva .D., Terekhin S.A., Melkozerov K.V.
Introduction into clinical practice of coronary angioplasty has provided new possibilities for treatment of coronary heart disease (CHD) in patientswith diabetes mellitus. The indications for endovascular interventions and principles of coronary stenting in such patients are described in this article.
Diabetes mellitus. 2011;14(1):61-68
Long-term outcomes of ophthalmosurgery in diabetic patients
Lipatov D.V., Bessmertnaya E.G., Kuzmin A.G., Smirnova N.B., Tolkacheva A.A., Chistyakov T.A.
Diabetes morbidity grows steadily despite recent progress in its diagnostics and treatment. Its most frequent complication is retinopathy although thereare increasingly more cases of diabetic cataract, secondary rubeous (neovascular) glaucoma, eyelid diseases, and transient impairment of vision.Aim To analyse late results of ophthalmosurgery in diabetic patients with vision problems.Materials and methods Over 24,000 patients were examined from January 2006 to November 2010 at the Department of Diabetic Retinopathyand Ophthalmosurgery, Endocrinological Research Centre. Results of more than 2660 seances of retinal laser coagulation and about 350 surgicalinterventions for diabetic cataract and secondary neovascular glaucoma were available for analysis.Conclusion Timely and correct application of retinal laser coagulation, modern facoemulsification of complicated cataract and drainage surgeryof uncompensated secondary rubeous glaucoma produces good functional results and permits to preserve or even improve visual acuity. The efficacyof surgical intervention is directly related to the quality of diabetes compensation and depends on the joint efforts of ophthalmologists, endocrinologists,and anesthesiologists.
Diabetes mellitus. 2011;14(1):69-73
Arterial diseases of lower extremities in diabetic patients: current state and prospects of therapy
Galstyan G.R., Tokmakova A.Y., Bondarenko O.N., Sitkin I.I., Pryakhina K.Y., Mitish V.A., Doronina L.P.
Peripheral artery diseases (PAD) are most serious diabetic complications responsible for the high risk of amputation of lower extremities. The occurrenceof PAD in diabetic patients is much higher than in subjects with undisturbed carbohydrate metabolism. PAD in diabetic patients is frequentlyan asymptomatic condition affecting distal portions of arterial segments and associated with pronounced mediacalcinosis. Standard diagnostic proceduresfor the screening of arterial lesions must be supplemented by non-invasive visualization and measurement of transcutaneous oxygen tensionin patients at risk of PAD and persisting foot ulcers. Of special importance is early diagnosis of critical limb ischemia and prevention of foot lesions.Combined treatment of diabetic foot syndrome in patients with critical limb ischemia includes normalization of foot circulation, surgical interventionand conservative therapy of the wound, monitoring concomitant micro- and macrovascular diabetic complications?
Diabetes mellitus. 2011;14(1):74-80
Diabetes mellitus and chronic kidney disease: achievements, unresolved problems, and prospects for therapy
Shestakova M.V., Shamkhalova M.S., Yarek-Martynova I.Y., Klefortova I.I., Sukhareva O.Y., Vikulova O.K., Zaytseva N.V., Martynov S.A., Kvaratskheliya M.V., Tarasov E.V., Trubitsyna N.P.
The dramatic increase in the number of patients with diabetes mellitus (DM) and chronic renal disease (CRD) in the recent years emphasizes the closeassociation between the two conditions and the leading role of DM in the development of renal pathology. Diabetology and nephrology are highly costlybranches of public health, and the burden of substitution renal therapy in DM patients continues to grow. The necessity of a renoprotection programat the early stages of DM for the prevention or delay of terminal renal insufficiency becomes increasingly clear. Such program should be based on theconceptual model of the evolvement of diabetic nephropathy as a consequence of combined action of metabolic and hemodynamic factors modulatedby genetic ones.
Diabetes mellitus. 2011;14(1):81-88
Upgrading Novopen insulin injection systems - 25 years experience
Galstyan G.R., Galstyan G.R.
The article deals with the estimate of efficiency and safety evaluation of Novopen insulin injection systems
Diabetes mellitus. 2011;14(1):90-93
Consensus statement by a panel of experts of the Russian Association of Endocrinologists (RAE) on initiation and intensificationof hypoglycemic therapy for type 2 diabetes mellitus
Dedov I.I., Shestakova M.V., Ametov A.S., Antsiferov M.B., Galstyan G.R., Mayorov A.Y., Mkrtumyan A.M., Petunina N.A., Sukhareva O.Y.
С учетом масштаба развивающейся эпидемии СД существует острейшая необходимость разработки эффективного терапевтического алгоритма сахароснижающего лечения, позволяющего достичь компенсации углеводного обмена и предупредить развитие тяжелых сосудистых осложнений этого заболевания. При этом приоритетом в выборе терапевтических средств должна стать эффективность сахароснижающего действия препаратов при их безопасности для пациентов (как крат- косрочной, так и отдаленной).
Diabetes mellitus. 2011;14(1):95-105
K svedeniyu avtorov
Diabetes mellitus. 2011;14(1):108-108

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