Vol 19, No 6 (2016)

Assessing routine healthcare pattern for type 2 diabetes mellitus in Russia: the results of рharmacoepidemiological study (FORSIGHT-DM2)
Dedov I.I., Kalashnikova M.F., Belousov D.Y., Rafalskiy V.V., Kalashnikov V.Y., Kolbin A.S., Yazykova D.R., Ivanenko L.R.

Rationale. The rising incidence of type 2 diabetes mellitus (T2DM) allows researchers to conduct observational multicentre studies and obtain objective information about the epidemiology of diabetes and its complications and evaluate the efficacy of different therapies and diagnostic strategies designed to identify systemic vascular complications.

Aims. To analyse epidemiological and socio-demographic parameters, the quality of glycaemic control, diagnostic monitoring and therapeutic measures typical among patients with T2DM living in Russian towns of different populations.

Materials and methods. FORSIGHT-DM2 is an all-Russian multicentre observational epidemiological study that involves 2014 patients with T2DM from 45 different towns in the Russian Federation (RF). All patients have had T2DM for at least 1 year. They received glucose-lowering therapy and primary medical care from RF public outpatient health institutions between 01.01.2014 and 31.12.2014. For comparative analysis of the typical treatment for patients with T2DM, we stratified patients into groups based on the number of residents.

Results. The data reveal a lack of glycaemic control (average НbА1с 7.9% ± 1.9%), with НbА1с > 8% in 36% of patients. The frequency of T2DM complications was high and the prevalence of retinopathy was 63.2%, nephropathy was 34.4% (7.8% had chronic kidney disease G3a-G5), peripheral polyneuropathy was 63.3%, ‘diabetic foot’ syndrome was 13.7% and osteoarthropathy was 5%. The number of T2DM-related complications is correlated with the HbA1c level and disease duration. Moreover, simultaneous influence of these factors led to a significant increase in the number of chronic complications associated with T2DM (r = 0.338 for T2DM duration, r = 0.262 for HbA1c; р < 0.001). Despite the high frequency of patient consultations with endocrinologists (83%) and a large percentage of hospitalisations in the current year (46%), the screening of chronic complications of T2DM in 2014 is insufficient.

Conclusion. The results indicate insufficient glycaemic control among patients with T2DM and a higher prevalence of chronic complications compared with the national register of diabetic patients.

Diabetes mellitus. 2016;19(6):443-456
Pathogenetic significance of single nucleotide polymorphisms in the gastric inhibitory polypeptide receptor gene for the development of carbohydrate metabolism disorders in obesity
Skuratovskaia D.S., Vasilenko M.A., Fattakhov N.S., Kirienkova E.V., Mironyuk N.I., Zatolokin P.A., Litvinova L.S.

Aim. To investigate the association of the GIPR gene polymorphisms rs2302382 and rs8111428 with increased risk of type 2 diabetes mellitus and abdominal obesity.

Materials and methods. The study involved 163 patients with abdominal obesity (BMI, 39.5 ± 8.3 kg/m2; age, 44.7 ± 8.9 years; men, 61; women, 102), 72 with type 2 diabetes mellitus (BMI, 43.70 ± 9.32 kg/m2; age, 46.5 ± 10.1 years; men, 29; women, 43) and 91 patients without carbohydrate metabolism disorders (BMI, 36.13 ± 6.72 kg/m2; age, 43.93 ± 8.35 years; men, 32; women 59). The control group comprised 109 relatively healthy volunteers (BMI, 22.6 ± 2.7 kg/m2; age, 39.5 ± 7.6 years; men, 66; women, 43). Genotypes were analysed by real-time PCR and serum insulin and C-peptide levels were evaluated by ELISA.

Results. The AA genotype in the rs2302382 polymorphism of GIPR was associated with an increased risk for type 2 diabetes mellitus in abdominal obesity and the CA genotype was associated with a reduced risk. In individuals with abdominal obesity and type 2 diabetes mellitus carrying the CA genotype in rs2302382 polymorphism of GIPR, serum insulin and C-peptide levels were elevated to 56.27 mU/L (55.49–58.41 mU/L) and 2.04 ng/ml (1.37–2.85 ng/ml), respectively (p < 0.05). In obese patients with the same genotype and without type 2 diabetes, serum insulin levels and C-peptide levels were 22.73 mU/L (19.07–25.76 mU/L) and 0.73 ng/ml (0.53–1.03 ng/ml), respectively (p < 0.05). The GIPR rs8111428 polymorphism was not associated with increased risk of type 2 diabetes mellitus in obesity for any of the groups examined.

Conclusion. Serum insulin and C-peptide levels were increased in patients with abdominal obesity who were carriers of the CA genotype in the rs2302382 polymorphism of GIPR, which is associated with a decreased risk of type 2 diabetes mellitus in obesity compared with the CC genotype.

Diabetes mellitus. 2016;19(6):457-463
Experimental Diabetology
Echinochrome pigment attenuates diabetic nephropathy in the models of type 1 and type 2 diabetes
Soliman A.M., Mohamed A.S., Marie M.S.

Background. The main complication of diabetes mellitus is diabetic nephropathy in both types, which is a main reason for renal failure. Echinochrome substance present in sea urchin shells and spines and possesses high antioxidant activity.

Aim. is to evaluate the ability of Ech to suppress the progression of diabetic complication in kidney.

Materials and methods. Thirty-six male Wistar albino rats were divided into two main groups, type 1 diabetes mellitus and type 2 diabetes mellitus. Both groups divided into control, diabetic and echinochrome subgroups. Type 1 diabetes was induced by single dose of streptozotocin (60 mg/kg, i.p), while type 2 was induced by high fat diet for 4 weeks before the injection with streptozotocin (30 mg/kg, i.p). The treated groups were administrated by echinochrome (1mg/kg body weight in 10% DMSO) daily for 4 weeks.

Results. Echinochrome groups showed reduction in the concentrations of glucose, malondialdehyde, urea, uric acid and creatinine. While it caused general increase in glutathione-S-transferase, superoxide dismutase, catalase, glutathione reduced, nitric oxide and creatinine clearance. The histopathological investigation showed clear improvement in the kidney architecture.

Conclusion. Administration of echinochrome improves renal function and ameliorates renal histopathological changes possibly by improvement of glucose metabolism and inhibition of lipid peroxidation process.
Diabetes mellitus. 2016;19(6):464-470
Myocardial revascularization in patients with coronary heart disease and type 2 diabetes
Bezdenezhnykh N.A., Sumin A.N.

The review discusses myocardial revascularization in patients with coronary heart disease and type 2 diabetes. The data presented include findings from recent research and international and national recommendations and provides evidence on the advantages of coronary artery bypass surgery over percutaneous coronary intervention for patients with diabetes mellitus, stable coronary artery disease and multiple coronary artery lesions. Type 2 diabetes remains a significant predictor of adverse long-term outcomes of coronary artery bypass surgery. Therefore, we review studies showing that different strategies of coronary revascularization and preoperative preparation can affect the results of coronary intervention in patients with diabetes.

Diabetes mellitus. 2016;19(6):471-478
Cornea and its changes in diabetes mellitus: the review
Bikbov M.M., Surkova V.K.
Diabetes mellitus (DM) is the most common endocrine disease, which makes it a priority among health and social problems. Ocular manifestations in diabetes often lead to patient disability. This review presents an analysis of morphological, experimental and clinical studies of the cornea in patients with diabetes mellitus, including original research, reviews and monographs of Russian and foreign authors from recent years. In addition, modern methods of corneal disease diagnosis are reviewed. Clinical and morphological changes in the diabetic cornea are discussed and early diabetic changes in all structural layers are indicated. The importance of changes to nerve fibres in diabetes is discussed and the correlation between the density of nerve fibres in the cornea and the density of epidermal nerve fibres is shown.
Diabetes mellitus. 2016;19(6):479-485
Diagnosis, control, treatment
Physical activity and type 2 diabetes mellitus risk: population studies review
Bogatyrev S.N.

Physical activity is one of the most important components of a healthy lifestyle. Regular physical activity helps to maintain normal blood glucose levels and reduce the risk of type 2 diabetes mellitus. This review presents population studies investigating physical activity as a factor for type 2 diabetes mellitus risk. A search using the keywords ‘physical activity’, ‘type 2 diabetes mellitus’ and ‘risk’ identified more than 40 relevant original studies and meta-analyses, which are presented in this review. Different types of physical activity have positive protective effects on type 2 diabetes mellitus risk and reduce the risk of death in patients with type 2 diabetes mellitus.

Diabetes mellitus. 2016;19(6):486-493
Empagliflozin as a new management strategy on outcomes in patients with type 2 diabetes mellitus
Salukhov V.V., Demidova T.Y.

Patients with type 2 diabetes mellitus have an increased risk of cardiovascular (CV) complications. Although hyperglycaemia contributes to the pathogenesis of atherosclerosis and heart failure in these patients, glucose-lowering strategies did not have a significant effect on reducing CV risk, particularly in patients with a long duration of type 2 diabetes mellitus and prevalent CV disease (CVD). Sodium-glucose linked transporter-2 (SGLT2) inhibitors are a new class of anti-hyperglycaemic medications that increase glycaemic control via insulin-dependent mechanism of action associated with increased urinary glucose excretion.

In this review, we present an analysis of the Empa-Reg Outcomes investigation, focussed on assessing the CV safety of empagliflozin, an inhibitor of SGLT2. We discuss the impressive results of trials that provide evidence on the cardiac and renal properties of empagliflozin. We present and analyse the current hypothesis on the mechanism of action of glucose-lowering medication, which has such a severe and complex impact on outcomes in patients with type 2 diabetes at high CV risk.

Diabetes mellitus. 2016;19(6):494-510
Comparative analysis of quality of life in patients treated with canagliflozine or DPP-IV inhibitor
Petunina N.A., Terekhova A.L., Goncharova E.V.

The article investigates the value of canagliflozin in the management of type 2 diabetes mellitus from the perspective of a clinically-based patient-centred approach. It focusses on the outcomes of a 52-week double-blind, active-controlled study. The results of this clinical trial demonstrate that canagliflozin, which provides significant weight loss ability, improves the quality of life and satisfaction with physical and emotional health in patients with diabetes compared with sitagliptin.

Diabetes mellitus. 2016;19(6):511-517
Economic aspects
Economic evaluation of type 2 diabetes mellitus burden and its main cardiovascular complications in the Russian Federation
Dedov I.I., Koncevaya A.V., Shestakova M.V., Belousov Y.B., Balanova J.A., Khudyakov M.B., Karpov O.I.

Background. Diabetes Mellitus Type 2 (DMT2) is a complex medical and social problem in the world and in the Russian Federation also due to prevalence and probability of cardio-vascular complications (CVC).

Aim. Economic burden evaluation of DMT2 in the Russian Federation.

Methods. Complex analysis of expenditures (direct and non-direct costs) based on epidemiological, pharmacoeconomics and clinical investigations, population and medical statistics data.

Results. Calculated expenditures for DMT2 are 569 bln RUR per year, that is correspond to 1% of the Russian GDP, and 34,7% of that are expenditures for main CVC (ischemic heart disease, cardiac infarction, stroke). Main part of expenses are non-medical (losses GDP) due to temporary and permanent disability, untimely mortality – 426,7 bln RUR per year. Expenditures in estimated group of patients with non-diagnosed DMT2 but with already having CVC were at least 107 bln per year (18,8% from total cost). Relationship between cost of DMT2 and degree of it’s control was found in the Russian conditions. Estimated cost for compensated patient (HbA1c<6,5%) per year was 88 982 RUR, in the same time cost of non-control patient (HbA1c>9,5%) was in 2,8 times higher due to more often main CVC in this group.

Conclusion. DMT2 diagnosis improvement as well as effective treatment of early stages of illness can decrease probability of CVC and social economic expenditures.


Diabetes mellitus. 2016;19(6):518-527
The History
In memory of Ivan P. Pavlov
Ipatova E.V.
Ivan P. Pavlov was the first Russian Nobel Prize winner, a great scientist, the pride of the national science community and ‘the first physiologist of the world’, as described by his colleagues at an international congress. 22 February 2016 marks 80 years since the death of the Russian scientist, physiologist Ivan Pavlov.
Diabetes mellitus. 2016;19(6):528-529

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