Vol 20, No 4 (2018)

Интервью с академиком РАН, доктором медицинских наук, профессором, заместителем директора по научной работе ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России - директором Института диабета Мариной Владимировной Шестаковой. Дулаглутид - инновационный препарат для лечения сахарного диабета типа 2 с введением 1 раз в неделю

Cardiovascular diseases are the leading cause of patients with diabetes mellitus mortality. Antiplatelet therapy is a crucial component of ischemic heart disease treatment and prevention, acetylsalicylic acid is the main drug of this group. The review presents modern approaches to primary and secondary prevention of unfavorable cardiovascular events in diabetes mellitus patients, meta-analyses results on effectiveness and safety of various doses and forms of acetylsalicylic acid and recent Russian and international clinical guidelines.

Aim. The aim of the study was to study the clinical manifestations and effectiveness of treatment of pulmonary tuberculosis with multidrug-resistant (MDR) Mycobacterium tuberculosis in patients with different types of diabetes mellitus (DM). Materials and methods. 66 patients with pulmonary tuberculosis combined with type 1 diabetes mellitus and 48 patients with pulmonary tuberculosis combined with type 2 diabetes were examined. Results and conclusions. It was found that in patients with type 1 DM, MDR tuberculosis was more often observed in men under 40 years of age, in the form of infiltrative pulmonary tuberculosis with the presence of destruction in lung tissue up to 2 cm in diameter with positive sputum and acute intoxication. In patients with type 2 DM, MDR tuberculosis was more often observed in men over the age of 40 in the form of fibrous-cavernous tuberculosis with the presence of destruction in lung tissue larger than 2 cm in diameter, with positive sputum and moderately severe intoxication. The effectiveness of treatment for negativation sputum in the compared groups did not differ significantly and amounted to 71.2% and 64.7% respectively. However, to close the caverns in the lung, the treatment was more effective in patients with type 1 diabetes, which is probably due to the peculiarities of the tuberculosis process in this category of patients.

The article describes the main diabetes mellitus type 1 and 2 complications. In-depth attention is given to diabetic neuropathy as it is one of the most widespread chronic complications and occurs approximately in 50% of diabetes patients. Pathogenic mechanisms of their development are discussed. Diagnostic criteria for diabetic neuropathies are presented. Classification, main clinical and paraclinical criteria and severity stages of the most common neuropathy type - diabetic distal symmetric polyneuropathy are reviewed. Differential-diagnostic characteristics of diabetic neuropathies are described. Main clinical manifestations of autonomic nervous system damage in diabetes mellitus patients are presented. Pasic principles and medications used in diabetic neuropathies treatment are described. The question of thioctic acid use in diabetic neuropathies treatment is addressed.

About 1/3 of a modern woman's life falls on menopause. Perimenopausal transition period is a critical period and it is essential to inform patients on possibilities of modern hormone therapy that allows not only to manage unfavorable menopausal symptoms and estrogen deficiency consequences but also to maintain woman's social activity and improve her quality of life. The article presents contemporary view on menopausal hormone therapy based on most recent relevant guidelines.

Multiple endocrine neoplasia type 1 syndrome is a rare genetic endocrine disease that requires timely diagnosis, early treatment and follow-up. Cancer awareness in patients with diagnosed and genetically confirmed multiple endocrine neoplasia type 1 syndrome relatives plays an important role. The article presents a clinical case with described disease course, laboratory and instrumental diagnostic tests results and disease treatment options.

Biological role of insulin is metabolic processes regulation of, firstly, fatty acids (FA) and, secondly, of glucose. Insulin is known to regulate phylogenetic transformation of sarcophagous (ichthyophagous) animals of the ocean to herbivorous animals on land. Seven etiologic factors of insulin resistance syndrome: 1) somatic cells do not absorb glucose while they are able to absorb FA; FA absorption is always more active. To force cells to absorb glucose insulin deprives them of FA in non-esterified FA form (NEFA) absorption opportunity; 2) insulin warrants the highest mitochondria productivity in adenosine triphosphate (ATP) production and high animal unit kinetics parameters. Insulin indirectly regulates glucose metabolism; glucose is a substrate for olein monounsaturated FA synthesis. Among long chain FA mitochondria oxidize it most actively, producing ATP; 3) insulin cannot block NEFA release if lipolysis in visceral fatty omentum cells was activated by phylogenetically earlier hormone. Isulin blocks lipolysis only in subcutaneous adipocytes; 4) biochemical activity of palmitic saturated FA (SFA) is low; it is high in olein monounsaturated FA (MFA). In such biological function as locomotion development insulin expresses de novo synthesis of two enzymes: palmytoil-CoA-elongase and stearoyl-CoA-desaturase. These enzymes turn all hepatocyte synthesized palmitate SFA to highly active olein MFA; 5) insulin turns to olein MFA only palmitate SFA which was synthesized from glucose de novo but not from meat food SFA; 6) cells absorb FA in olein triglycerides form by apoE/В-100-endocytosis more actively than palmitate triglycerides by apoВ-100-endocytosis; 7) lack of ATP mitochondria production in trophology biologic function in mitochondria oxidation of palmitate SFA is to be compensated by biologic adaptation function activation, biologic endotrophy reaction, lypolysis in visceral fatty omentum cells and NEFA release. High NEFA serum level is the most common reason for insulin resistance syndrome.