Vol 28, No 4 (2026): Endocrinology

Background. Psoriasis is a systemic immune-mediated inflammatory disease with a high risk of comorbid conditions, among which metabolic syndrome (MS) is of particular importance. The association of MS with plaque psoriasis has been best studied, while data on its prevalence in rare clinical variants, particularly palmoplantar pustular psoriasis (PPP), are limited.

Aim. To study the prevalence of metabolic syndrome and its components in young patients with various forms of psoriasis.

Materials and methods. The study included 106 patients with psoriasis, divided into three groups: Group 1: 31 patients with palmoplantar pustular psoriasis, Group 2: 37 patients with plaque psoriasis complicated with psoriatic arthritis, and Group 3: 38 patients with plaque psoriasis without arthritis. All patients underwent an assessment of clinical and demographic parameters, skin disease severity using the PASI index, blood lipid profile parameters, fasting glucose and insulin levels, and calculation of the HOMA-IR insulin resistance index. Metabolic syndrome was diagnosed using unified international criteria and the criteria of the All-Russian Scientific Society of Cardiologists (VNOC).

Results. The prevalence of metabolic syndrome according to international criteria was 42.0% in the PPP group, 37.8% in patients with plaque psoriasis and psoriatic arthritis, and 26.3% in patients with plaque psoriasis without arthritis. According to the All-Russian Society of Cardiologists criteria, similar figures were 45.2, 40.5, and 31.6%, respectively. Patients with PPP and patients with psoriatic arthritis had statistically significantly higher levels of insulin and HOMA-IR index compared with patients with isolated plaque psoriasis. Insulin levels and HOMA-IR index were statistically significantly higher in groups 1 and 2 (8.0 [5.47; 13.6] and 11.55 [9.90; 16.08]; 1.99 [1.22; 3.93] and 2.89 [2.43; 4.53], respectively) compared with group 3 (3.56 [2.29; 6.63]; 0.83 [0.67; 1.66]).

Conclusions. Hyperinsulinemia and insulin resistance in patients with PPP and MS likely reflect the existing pathogenetic differences between pustular and plaque psoriasis. The findings may be useful for clinical practice when screening for metabolic disorders in young patients.

The discovery of high concentrations of insulin receptors in the brain has refuted the notion of the central nervous system as an insulin-independent organ and laid the foundation for the concept of central insulin signaling. Currently, insulin has been shown to modulate neuronal activity, synaptic plasticity, memory, and metabolism. Conversely, insulin deficiency or resistance leads to cognitive impairments, as demonstrated in type 2 diabetes mellitus (T2DM), Alzheimer's disease (AD), and other pathologies. It has been established that central insulin resistance in T2DM is not always secondary to peripheral resistance and can arise independently, as observed in AD. This review provides a detailed analysis of the prospects of intranasal insulin administration (INI) as an innovative method for direct cerebral delivery of insulin, bypassing the blood-brain barrier via olfactory pathways. This approach leverages the anatomical feature of the olfactory epithelium, where a fully formed the blood-brain barrier is absent, allowing insulin molecules to penetrate directly into the brain through perineuronal spaces of olfactory nerve axons and the vascular network of the olfactory bulb. The key advantages of INI include minimal systemic absorption, which minimizes peripheral effects, and the complete absence of hypoglycemia risk even with repeated administration, unlike subcutaneous or intravenous injections. Randomized controlled trials convincingly confirm the efficacy of INI: in patients with T2DM, improvements in memory and perfusion in the insular cortex are observed; in AD, acceleration of gait, enhanced cerebral blood flow, improved resting-state functional connectivity, reduced HOMA-IR index, and preservation of cognitive functions are noted; additionally, motor progress in Parkinson's disease and reduced incidence of postoperative cognitive dysfunction are demonstrated. INI is positioned as an innovative strategy to reduce central insulin resistance and improve cognitive functions in various patient populations. However, despite promising results from preliminary randomized controlled trials demonstrating the safety, tolerability, and therapeutic potential of INI, further studies are required for its full integration into clinical practice.

Background. Diabetic foot syndrome (DFS) complicated by osteomyelitis is one of the most severe complications of diabetes mellitus. This disease has significant socio-medical importance because it often leads to limb amputation. Studying the morphological features of osteomyelitis in DFS makes it possible to clarify the pathogenesis, determine the nature of inflammatory changes, and assess the rate of reparative processes, which is important for justifying treatment strategies.

Aim. To study the morphological features of osteomyelitis in patients with DFS.

Materials and methods. Histological analysis was performed on wound tissue samples from 75 patients with DFS complicated by osteomyelitis, who were treated at the City Diabetic Foot Center based on the surgical department of the Central City Clinical Hospital No. 9 in Donetsk, from January 2024 to July 2025. The patient cohort included 33 women (44%) and 42 men (56%), with an average age of 45.6±8.2 years (range: 40–84). Tissue samples were obtained using incisional biopsy of the affected bone. After fixation, decalcification, and processing, the specimens were stained with hematoxylin and eosin and examined under light microscopy.

Results. In 66 cases, massive sequestra were identified, represented by acellular fragments of bone trabeculae surrounded by a connective tissue capsule. In 53 cases, a pronounced sequestral capsule with purulent inflammation was detected, and in some patients, areas of necrotic debris were observed. In 42 cases, granulation tissue was noted at the boundary between the sequestra and the capsule, accompanied by lymphocytic-macrophage infiltration. Osteoblast proliferation foci were present in 58 cases, while osteoclast predominance was observed in 17 cases. In 40 cases, areas of fibrous degeneration of bone tissue were found, limiting reparative processes.

Conclusion. Chronic osteomyelitis in DFS demonstrates specific morphological features: persistent large bone sequestra, formation of a connective tissue capsule, development of granulation and scar tissue, pronounced necrotic changes, and a tendency toward sclerosis. These features explain infection persistence, predisposition to recurrence, and impaired reparative processes in patients with diabetes mellitus. The study of morphological features of osteomyelitis is essential for optimizing diagnostics and selecting effective treatment strategies.

Background. Diabetic polyneuropathy (DPN) is the most common neurological complication of diabetes mellitus, detected in 90–100% of patients. Disease progression is accompanied by the development of pain syndrome, motor impairments, and loss of static balance, which significantly increases the risk of falls and leads to persistent disability. Despite a wide range of pharmacological agents, the restoration of motor and static functions in patients with DPN remains an insufficiently addressed issue, justifying the need for the development and implementation of comprehensive medical rehabilitation programs.

Aim. To evaluate the efficacy and safety of a novel comprehensive medical rehabilitation method on motor and static function parameters, as well as on the severity of symptoms assessed by the Neurological Symptoms Score (NSS), in patients with the sensorimotor form of DPN.

Materials and methods. This article presents the results of a clinical trial involving 120 patients with distal sensorimotor DPN (43 men, 77 women; median age – 60.0 [54.0; 66.0] years), randomized into a main group (n=60) and a control group (n=60). The 19-day medical rehabilitation course for the main group included therapeutic exercises, stabilometric platform training with biofeedback, pneumovibromassage of the lower extremities, and isotonic exercises on biofeedback-equipped devices (15 sessions of each method). The control group received therapeutic exercises only. Efficacy was assessed by the dynamics of pain syndrome (Visual Analogue Scale), severity of neurological symptoms (NSS scale), and functional tests (10-meter walk test, Timed Up and Go test, Fukuda stepping test) at baseline, on day 19, and on day 54 of follow-up.

Results. In the main group, a statistically significant reduction in pain intensity on the Visual Analogue Scale (from 6.2 [5.0; 8.0] to 4.5 [3.0; 6.0] points by day 54; p< 0.001) and a decrease in the severity of neurological symptoms on the NSS scale (from 7.1 [6.0; 8.0] to 5.24 [4.0; 6.0] points; p< 0.001) were recorded. Improvement in gait speed characteristics (increased 10-meter walk test speed; p< 0.01) and static balance (increase in the number of steps in the Fukuda test from 62.61 [40.0; 75.0] to 77.14 [53.0; 100.0]; p< 0.05) was observed. In the control group, no significant changes were found in most parameters (p>0.05). Intergroup differences reached statistical significance in favor of the main group (p< 0.05–0.001). The Timed Up and Go test score did not change significantly in either group (p>0.05). No adverse events were reported.

Conclusion. The comprehensive medical rehabilitation method provides a statistically significant reduction in pain syndrome and neurological deficit, improvement in gait speed characteristics, and static balance in patients with the sensorimotor form of DPN. The method is characterized by a favorable safety profile and can be recommended for inclusion in clinical practice.

Background. Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by impaired carbohydrate and lipid metabolism, which is associated with an increased risk of cardiovascular complications. Dyslipidemia (DLP) represents one of the principal risk factors for cardiovascular disease among individuals with T2DM. Recent discussions have highlighted the role of the intestinal microbiota in the pathogenesis of T2DM, particularly through the production of short-chain fatty acids, with a particular emphasis on butyric acid (butyrate). Butyrate regulates energy metabolism, mitigates inflammation, modulates incretin secretion, and enhances insulin sensitivity in tissues. Inulin, a recognized prebiotic, stimulates endogenous butyrate production. The use of controlled-release fixed combinations of butyrate and inulin may amplify these metabolic effects.

Aim. To investigate the impact of the combination of butyric acid and inulin (Zakofalk®) on carbohydrate and lipid metabolism in patients with newly diagnosed T2DM and DLP.

Materials and methods. This open-label prospective study involved 50 patients aged 40 to 65 years with newly diagnosed T2DM and DLP, all presenting with abdominal obesity, a body mass index of less than 40 kg/m², glycated hemoglobin (HbA_1c) levels exceeding 7.0%, and classified under Frederickson type IIb DLP. The test group received Zakofalk® alongside metformin, while the control group received metformin only. The follow-up period was 12 weeks. Сarbohydrate and lipid metabolism was assessed before and after the intervention. Statistical analyses were performed using SPSS 11.0 for Windows, applying standard methods of variational statistics.

Results. The fasting glycemia level after three months of treatment in the test group decreased from a baseline of 6.8±0.4 to 6.5±0.8 mmol/L (p< 0.05). In contrast, the control group noted a reduction from 6.8±0.5 to 6.6±0.2 mmol/L (p< 0.05). Inter-group analysis revealed a significantly greater improvement (p< 0.05) in fasting glycemia in the Zakofalk® group, with an average reduction of 0.1 mmol/L. The postprandial glycemia level also declined significantly in both groups post-treatment, with the test group decreasing from 7.2±0.6 to 6.9±0.76 mmol/L (p< 0.05) and the control group decreasing from 7.3±0.3 to 6.9±0.4 mmol/L (p< 0.05). The changes in postprandial glycemia indicated a more pronounced decrease, averaging 0.1 mmol/L, within the control group exhibiting higher baseline values (p< 0.05). The HbA_1c level at three months decreased by 0.17% in the test group, from 7.17 to 7.0% (p< 0.05), whereas in the control group, it decreased by 0.05%, from 7.2 to 7.15% (p< 0.05). Notably, there was a significant difference between the groups in the change of HbA_1c of 0.1%, favoring the test treatment group (p< 0.05). Additionally, total cholesterol levels in the test group decreased from 6.2±0.4 to 5.8±0.2 mmol/L after 3 months (p< 0.05). Conversely, the control group showed a reduction from 6.2±0.5 to 6.1±0.2 mmol/L (p=0.42), with a statistically significant difference between the groups post-treatment (p=0.001). The level of triglycerides (TG) in the test group significantly fell from 1.9±0.3 to 1.7±0.2 mmol/L (p=0.001), whereas the control group exhibited no change (1.9±0.2 mmol/L at baseline vs. 1.9±0.1 mmol/L) (p=0.56). A significant inter-group difference in TG reduction was observed after treatment (p=0.001). High-density lipoprotein levels did not show any significant changes pre- or post-treatment in either group, yielding unreliable data. Low-density lipoprotein levels decreased significantly post-treatment in both groups, with the test group showing a reduction from 3.4±0.4 to 3.1±0.2 mmol/L (p=0.02), and the control group from 3.4±0.5 to 3.3±0.1 mmol/L; however, these changes were not statistically significant (p=0.457). A significant difference in the decrease in TG level was observed between the study groups after treatment (p=0.008). The treatment was well tolerated.

Conclusion. The introduction of a combination of butyric acid and inulin (Zakofalk®) alongside metformin therapy improved carbohydrate and lipid metabolism in patients with newly diagnosed T2DM and DLP, including a reduction in TG levels. These results suggest a potential therapeutic role for this approach in addressing metabolic disorders. Given the limitations of this study, further confirmation of these findings in larger and controlled trials is warranted.