Vol 25, No 4 (2023)


Diagnosis and treatment of prediabetes as prevention of type 2 diabetes: A review

Petunina N.A., Martirosian N.S., Khachaturov M.V., Zhutaeva M.A., Shaposhnikova A.A., Karpenko E.V., Abdulganieva Z.A.


Prediabetes is defined as a disorder in which the criteria for diabetes mellitus are not met, but normal blood glucose values are exceeded; this intermediate hyperglycemia is associated with a high risk of developing diabetes and cardiovascular disease. The number of patients with diabetes mellitus continues to grow steadily, and therefore the role of timely interventions at the stage of prediabetes is obvious. A modern approach to preventing the progression of prediabetes includes correcting risk factors for cardiovascular diseases, arterial hypertension, dyslipidemia, weight loss and/or prevention of weight gain, and improving the quality of life. The first-line therapy for prediabetes is lifestyle modification, which includes changes in diet, physical activity, weight management, bad habits, and sleep hygiene. Thus, a non-pharmacological approach to the treatment of patients, aimed at reducing excess weight, plays a major role. In conditions of insufficient effectiveness of measures to change lifestyle, it is advisable to prescribe drug therapy. Metformin is the first-line drug for preventing the progression of carbohydrate metabolism disorders. In addition to lifestyle modification, orlistat, drugs from the group of GLP-1 analogues, thiazolidinediones, and acarbose have also demonstrated their effectiveness. Bariatric surgery is associated with improved glycemic control in prediabetic patients.

Consilium Medicum. 2023;25(4):229-235
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Cardiovascular outcomes of dapagliflozin in type 2 diabetes mellitus in real clinical practice: a meta-analysis of observational studies

Antsiferov M.B., Demidov N.A.


Aim. To conduct a meta-analysis of population-based observational studies of dapagliflozin compared with therapy without iNGLT-2 to assess its effect on the risk of cardiovascular events in patients with type 2 diabetes mellitus in real-world practice.

Materials and methods. A systematic search was carried out in 3 bibliographic databases – PubMed (Medline), Embase and eLibrary. According to the search results, 1,451 records were identified. 3 studies were selected for inclusion in the meta-analysis: CVD-REAL Nordic, EASEL Population-Based Cohort Study and CARDIA-MOS. The criteria for evaluating the effectiveness were the frequency of major adverse cardiovascular events (MACE) and cardiovascular mortality. The meta-analysis was carried out in the RevMan 5.4.1.

Results. According to the results of the meta-analysis, there was a statistically significant association between the use of dapagliflozin and a decrease in the risk of MACE: relative risk 0.73, 95% confidence interval 0.65–0.82, as well as a decrease in cardiovascular mortality: relative risk 0.67, 95% confidence interval 0.48–0.92.

Conclusion. Our results demonstrated that the use of dapagliflozin is associated with a reduction in the risk of developing MACE and cardiovascular mortality in patients with type 2 diabetes mellitus with cardiovascular diseases or cardiovascular risk factors.

Consilium Medicum. 2023;25(4):236-240
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Difficulties in differential diagnosis of carbohydrate metabolism disorders in patients with coronavirus infection in real clinical practice. Case report

Markova T.N., Stas M.S., Chibisova V.V., Anchutina A.A.


The problem of the impact of coronavirus infection on carbohydrate metabolism remains open. In the course of the disease, various disorders of carbohydrate metabolism are detected, including newly diagnosed diabetes mellitus and transient hyperglycemia. This article presents two clinical cases with different course and duration of transient stress hyperglycemia against the background of coronavirus infection.

Consilium Medicum. 2023;25(4):241-246
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Highly selective sodium glucose cotransporter type 2 inhibitor empagliflozin neuroprotective potential in chronic brain dyscirculation

Fuks О.S., Simanenkova A.V., Timkina N.V., Tikhomirova P.A., Gagiev A.Z., Karonova T.L.


Background. Chronic brain dyscirculation occurs in type 2 diabetes mellitus (DM2) with a high frequency and leads to patients’ disability. The early diagnosis of this disorder is difficult. Sodium-glucose cotransporter type 2 inhibitors are among the priority antidiabetic drugs due to their pronounced cardioprotective effect, but their effect on the central nervous system has not been studied enough.

Aim. To study empagliflozin effect on clinical and laboratory parameters of brain damage in patients with DM2.

Materials and methods. The study included patients with DM2 on metformin therapy (n=52). Patients with target glycated hemoglobin level formed the “MET” group (n=18), in those with non-target glycated hemoglobin level empagliflozin was added for 6 months (group “MET+EMPA”; n=19). A healthy control group was also created (n=15). The cognitive status and concentration of neurofilament light chains were studied.

Results. In patients of the “MET” group, despite the target level of glycated hemoglobin, there was a cognitive deficit, according to the Montreal Cognitive Assessment: 25.0 (21.0; 27.0) points with a norm of 26 points or more. Therapy with empagliflozin led to the normalization of cognitive status after 6 months: 26.5 (24.0; 27.0) points. Initially, all patients had an increased neurofilament light chains level: 4.50 (3.31; 5.56) ng/ml in the “MET” group, 5.25 (3.75; 6.25) ng/ml in the “MET+EMPA” comparing with 3.50 (2.25; 3.50) ng/ml in the “Control” group. Empagliflozin therapy led to a decrease in this parameter after 3 months: 3.80 (3.25; 3.87) ng/ml – and maintenance of this level after 6 months.

Conclusion. DM2 is accompanied by pathological changes in the central nervous system even under satisfactory glycemic control. Empagliflozin therapy causes an improvement in cognitive status and a decrease in the level of neurofilament light chains.

Consilium Medicum. 2023;25(4):247-252
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Non-alcoholic fatty liver disease and cardiovascular risks: A review

Kotovskaya Y.V.


Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease. NAFLD may be associated with concomitant metabolic disorders (obesity, type 2 diabetes mellitus, dyslipidemia) and is often considered a hepatic manifestation of metabolic syndrome. In addition to hepatic morbidity and mortality, NAFLD is closely associated with asymptomatic and overt cardiovascular disease (CVD), leading to increased cardiovascular morbidity and mortality, and the more severe the hepatic disorder, the higher the risk. This review describes the main pathophysiological mechanisms linking NAFLD and CVD, discusses the role of NAFLD as a CVD risk factor, and addresses non-drug and drug therapies for NAFLD in the context of cardiovascular risk reduction. NAFLD makes patients candidates for more intensive therapeutic intervention to reduce hepatic and cardiovascular risks. Lifestyle modifications, including weight loss, increased physical activity, and nutritional adjustment, form the basis of NAFLD treatment. Correction of cardiovascular risk factors includes statins, antihypertensive agents, preferably renin-angiotensin system blockers. Ursodeoxycholic acid has therapeutic potential for beneficial effects on hepatic disorders and reducing cardiovascular risk.

Consilium Medicum. 2023;25(4):253-258
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Safety of dapagliflozin initiation in acute decompensated heart failure patients with reduced left ventricular ejection fraction

Poskakalova A.E., Nasonova S.N., Zhirov I.V., Tereshchenko S.N.


Background. Chronic heart failure (CHF) is an immediate cardiological problem. At the same time, acute decompensated heart failure (ADHF) is associated with an extremely unfavorable prognosis and low survival of patients.

Aim. To evaluate the safety of sodium-glucose cotransporter-2 inhibitor dapagliflozin early administration in patients with ADHF with a reduced left ventricular ejection fraction (LVEF) regardless of type 2 diabetes mellitus (diabetes).

Materials and methods. We used standard CHF therapy and intravenous diuretic therapy in combination with 10 mg dapagliflozin in 43 patients with NYHA class II–IV ADHF. The study mainly included 39 (90.7%) male patients, the mean age was 60±12 years (56–63), diabetes was in 14 (32.6%) patients. Dapagliflozin was prescribed by a mean of 2 days (1–3) from admission to the hospital. The parameters were analyzed at the time of inclusion in the study and when CHF compensation was achieved.

Results. The median of the length of hospital stay was 7 days (6–10). LVEF significantly increased during hospitalization from 27±6 to 30±7% (p<0.001) and the level of NT-proBNP decreased: from 3700 pg/ml (1745–5331) to 1366 pg/ml (1025–2878); p=0.007. A decrease in the marker was observed in 90% of patients. Hypotension (decrease in systolic blood pressure – BP less than 90 mmHg) was observed in 10 (23.3%) patients. A statistically significant decrease in BP was found: systolic and diastolic BP on admission was 114 mmHg (100–126) and 70 mmHg (70–80), respectively, when CHF compensation was achieved – 110 mmHg (98–120) and 70 mmHg (61–78); p=0.047 and p=0.013, respectively. The increase in hematocrit during hospitalization was also statistically significant – from 43.5±3.6 to 46.1±4.9% (p<0.001) and this was found in 67% of patients. A total of 4 (9.3%) patients had acute renal injury (decrease in estimated glomerular filtration rate – GFR by 25% or more). At the same time, there was no decrease in GFR of less than 15 ml/min/1.73 m2. There was no statistically significant decrease in GFR and an increase in creatinine levels during hospitalization (p=0.214 and 0.173, respectively). Urinary tract infections were observed in 1 (2.3%) patient, transient hypoglycemia – in 2 (4.7%) patients, which did not lead to the discontinuation of dapagliflozin. Diabetic ketoacidosis, allergic reactions, syncope, lower extremity amputations were not observed in patients taking dapagliflozin.

Conclusion. It can be concluded that dapagliflozin has a favorable safety profile when used in patients with ADHF, regardless of the presence or absence of diabetes.

Consilium Medicum. 2023;25(4):259-265
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Methods for determining iodine in urine

Nikankina L.V., Zuraeva Z.T., Troshina E.A.


Iodine deficiency remains a serious threat to public health worldwide, especially in children and pregnant women. Despite the apparent ease of iodine deficiency elimination with the help of a simple and highly effective strategy of compulsory salt iodization, the problem of iodine deficiency and iodine deficiency disorders remains urgent for public health in the Russian Federation. The most effective and informative way to study iodine status at population level is determination of iodine concentration in urine in epidemiological studies. This article presents a review of urinary iodine determination methods, as well as methodological recommendations for iodine determination, developed and adopted in National Medical Research Center for Endocrinology.

Consilium Medicum. 2023;25(4):267-273
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Subacute thyroiditis: clinical significance of diffuse 18-fluorodeoxyglucose uptake. Case report

Ognerubov N.A., Antipova T.S., Palkina E.E.


Background. Subacute thyroiditis is a rare inflammatory thyroid disease presumably associated with viral infection, including COVID-19. It accounts for about 5% of all thyroid diseases.

Materials and methods. A clinical case of de Quervain's subacute thyroiditis in a patient with diffuse hypermetabolic 18-fluorodeoxyglucose uptake by the thyroid gland is presented.

Results. A 61-year-old patient with no history of thyroid disorders 3 weeks after COVID-19 experienced fever in the evenings (37.8–39.8°C). He had moderate pain in the thyroid gland with radiation to the jaw, severe weakness, hand tremors, shivers, 12 kg weight loss, and sweating. These symptoms lasted for 3 weeks. Physical examination showed an enlarged thyroid gland, dense and extremely tender, especially its left lobe. Ultrasound showed an enlarged thyroid gland with a heterogeneous structure and large hypoechoic areas in both lobes up to 4×7 mm with fuzzy contour. Color Doppler imaging revealed reduced blood flow. Combined positron-emission and X-ray computed tomography with 18-fluorodeoxyglucose showed an increased diffuse uptake of the radiopharmaceutical in the thyroid gland and enlargement of its lobes, SUVmax 10.55. Blood thyroid-stimulating hormone is low, free triiodothyronine and thyroxine are high, and ferritin concentration is markedly increased, consistent with thyrotoxicosis. A fine-needle aspiration biopsy was performed. Cytology confirmed de Quervain's subacute thyroiditis. Glucocorticoids and nonsteroidal anti-inflammatory drugs were administered. Four weeks after the treatment, the clinical manifestations resolved. The patient was assessed in 6 months. Ultrasound showed a thyroid gland of regular size with smooth contours; color Doppler mapping revealed normal blood flow. Thyroid-stimulating hormone, triiodothyronine, and thyroxine were within reference ranges.

Conclusion. The SARS-CoV-2 virus can be regarded as the cause of subacute thyroiditis. Combined positron-emission and X-ray computed tomography with 18-fluorodeoxyglucose showed diffuse intensive radiopharmaceutical uptake in the thyroid gland. Cytology is the basis for differential diagnostics. Glucocorticoids and nonsteroidal anti-inflammatory drugs are the first-choice agents.

Consilium Medicum. 2023;25(4):274-277
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Approach to the patient with adrenal incidentaloma. Case series

Ladygina D.O., Zorina A.A., Berkovskaya M.A., Chevais A., Beltsevich D.G., Fadeev V.V.


The formations of the adrenal glands are often detected accidentally during instrumental methods of examination of the abdominal cavity and retroperitoneal space, performed for some other reasons. Over the past 2 decades, the frequency of detection of adrenal gland formations has increased 10-fold, and most of them are diagnosed in old age. The tactics of observation and treatment depend both on hormonal activity and on the malignant potential of the detected formation. Up to 5–8% of patients with adrenal incidentalomas have a malignant nature, with a higher risk in young patients, with a size of more than 4 cm, as well as with a history of other malignant neoplasms. The frequency of detection of the classical clinical and laboratory picture of hypercorticism, hyperaldosteronism or catecholamine-producing tumor is less than 15%, however, the phenomenon of functionally autonomous cortisol production according to the results of studies conducted in the last few years is much more common – up to 30–50% of patients. Despite the absence of vivid clinical symptoms in some cases, autonomous cortisol secretion is associated with increased cardiovascular morbidity and metabolic disorders, therefore, all patients with adrenal incidentalomas need to exclude this condition. This article presents clinical cases of patients with adrenal gland formations, describes in detail the examination algorithm and the choice of treatment tactics, taking into account the results of studies conducted since the release of the latest clinical recommendations for the management of patients with adrenal gland incidentalomas in 2016.

Consilium Medicum. 2023;25(4):278-286
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