Vol 25, No 4 (2023): Endocrinology

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.

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.

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.

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.