Vol 21, No 4 (2019)

Russian Federation refers to countries with proven natural iodine deficiency. Iodine deficiency disorders are pathological conditions that develop because of iodine deficiency in the diet, which can be prevented by normalization of its intake. Many counties of the world achieved significant decline in the incidence of thyropathies, associated with iodine deficiency, through the legislative of universal salt iodization, but in Russian Federation, this problem remains relevant. The aim of this review was to complain epidemiological characteristics of iodine deficiency-associated thyropathies in various regions of Russia, based on the analysis of the latest publications on this topic and the data provided by official statistics (Rosstat); we formulated conclusions. In Russia again registered an increase in the frequency of cretinism (severe mental retardation), associated with severe intrauterine iodine deficiency. Calculations show that about 1.5 million people in Russia may have mental retardation and related disability due to iodine deficiency in diet. Thus, the relevance and consequences of the iodine deficiency problem are obvious.

Aim. To evaluate fitness of Contour® TS glucometer (Contour® TS, Bayer/Ascensia*) - a system for blood glycemia level control, and its characteristics in everyday use for Russian patients with insulin dependent diabetes mellitus (DM) types 1 and 2 and endocrinologists. Study design. According to the inclusion criteria, 3759 patients were registered in the program, of which 3599 patients have completed the study as per 3 visits. The non-interventional study was conducted in 84 medical centers in RF during the period from October 2013 to June 2015. Age of insulin-dependent patients and patients on hypoglycaemic therapy was 18 years and older. Results. Observational program included - 1126 (31.29%) patients with type 1 diabetes mellitus and 2473 (68.71%) patients with type 2 diabetes mellitus. Following switch to Contour® TS, while insulin therapy regimens were maintained, it was noted that the rate of blood glucose measurement increased compared with Visit 1 (p<0.0001). Upon assessment of satisfaction with the device, virtually all questions were answered as “good” and “perfect” by more than 90% patients and 95% study doctors. Upon assessment of the quality of life by EQ-5D, increase of this parameter was noted in 6 months, at Visit 3 (p<0.0001). No glucometer-associated malfunction were registered during the study. Additional data from general clinical experience of each patient that allowed to establish significant reduction of the levels of glycosilated haemoglobin and pre-prandial blood glucose just in 3 months at Visit 2, significant reduction of reported hypoglycaemia episodes as calculated per one patient have been obtained during the study. Additional data on the prevalence of macro- and microvascular complications were obtained during the study, and the highest per cent was for non-proliferative retinopathy and nephropathy at the stage of albuminuria. The most common among concomitant diseases were arterial hypertension, dyslipidemia and coronary artery disease. Conclusion. Use of Contour® TS glucometer by the patients, while insulin therapy regimens were maintained, led to increase in the rate of blood glucose measurements by up to 4-6 times during the day and statistically significant improvement in blood glucose control.

According to modern view treatment of patients with diabetes mellitus is aimed not only at reaching target glycemic control levels but also at preventing development and progressing of late diabetes mellitus complications, improvement of quality of life and increase of life expectancy of patients. The relevance of the diabetes treatment research is explained with growing disorder prevalence including its prevalence in older population. Over the last years new classes of antihyperglycemic medications came into use: dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 agonists, and sodium-glucose linked transporter-2 inhibitors. Long-term experience of DPP-4 inhibitors use allows to conclude not only of effectiveness of medications of this class but also of their safety. Several studies of DPP-4 inhibitors use in older patients with comorbid disorders and renal impairment have been conducted including studies in real clinical practice. Results of studies of cardiovascular safety of medications from DPP-4 inhibitors class in patients with diabetes mellitus type 2 have been published. The article discusses the issues of antihyperglycemic therapy choice and the place of DPP-4 inhibitors in clinical practice.

In the last decades all over the world surgical methods are used more widely for severe obesity treatment. A tendency is evident both in increase of the amount of operations and in increase of the number of countries where bariatric surgery becomes more widely spread. Indications and contraindications for bariatric surgery are presented in the guidelines including specific ones - in patients with type 2 diabetes mellitus (DM2). Different types of bariatric surgical interventions and mechanisms of influence on body mass, carbohydrate and lipid metabolism as well as main results in obese patients including ones with DM2 are described. The requirements for bariatric surgical interventions and parameters of their effectiveness estimation including DM2 remission are presented. The causes of postbariatric hypoglycemia and predictors of post-operation prognosis in relation to metabolic control in obese patients with DM2 are analyzed.

Recently, doctors face the problem of patients with hypoglycemia conditions caused by the use of drugs that are not drugs for the treatment of diabetes. This is due to the increase in the number of multimorbid diseases in people of older age groups and, consequently, an increase in the number of drugs used simultaneously (polypharmacy). Hypoglycemia can complicate the course of concomitant diseases, contributes to the occurrence of arrhythmias, increases the risk of cardiovascular events, cognitive impairment, including dementia, increases the frequency and duration of episodes of myocardial ischemia. Risk factors for the development of drug-induced hypoglycemia include: elderly and senile age; reduced glomerular filtration rate, liver failure (reduced gluconeogenesis), reduced food consumption (insufficient glucose consumption); excessive alcohol consumption (reduced gluconeogenesis, insufficient food intake); simultaneous intake of several drugs that can lead to hypoglycemia. The most frequently drug-induced hypoglycemia develops against the background of the use of quinolones, pentamidine, quinine, β-blockers, angiotensin-converting enzyme inhibitors and insulin-like growth factor. The main vehicle to prevent drug-induced hypoglycemia is to stop its use and/or replace it with another drug that does not have this side effect. If it is impossible to completely abandon the drug, it is necessary to minimize the risk of hypoglycemia in the following ways: use long-term administration of the same concentration of the drug (if possible, prolonged forms), reduce the dose of the drug (use the lowest possible effective doses), control the concentration of glucose in the blood.

Insulinoma is the most common functioning tumor of the pancreas. Approximately 5% of cases of the disease is associated with the syndrome of multiple endocrine neoplasia type 1 (MEN-1), caused by mutation in the gene MEN1. The MEN-1 is manifested by pituitary adenomas and adenomas of parathyroid glands, pancreatic neuroendocrine tumors, tumors of thyroid gland, adrenal glands, intestine, carcinoids of lungs and other organs. Patients with MEN-1 often have angiofibromas, collagenomas and lipomas. However, in 5-10% of patients with clinical manifestations of this syndrome, mutations in MEN1 cannot be detected. In such cases, the disease can be caused by various disorders (mutations, polymorphisms, etc.) in other genes. More than 10 genes, associated with insulin-producing pancreatic tumor, are described in the literature. In the presented clinical case, an extended genetic study was performed in a young patient with insulinoma and a suspicious phenotype of MEN-1. The article emphasizes the need to search for new genetic markers that predispose to the development of insulinoma, and the subsequent introduction of panel of genes sequencing in such patients. Genetic testing is indicated primarily for young patients with multifocal lesions, family history and associated pathology.

The lecture is addressed to doctors of various specialties and devoted to the role of vitamin D in the prevention of bone and metabolic disorders. Modern data on the physiological effects of vitamin D confirm its multifactorial effect on the skeletal and muscular systems, both direct and indirect. The mutual influence of obesity and vitamin D deficiency is determined by several mechanisms, while the decrease in the bioavailability of vitamin D in obesity causes the development of secondary hyperparathyroidism. The existing algorithms for prevention and treatment of vitamin D deficiency involve not only the initial level of 25(OH)D, but also the patient's age, body mass index, and the presence of concomitant diseases. Modern clinical guidelines of the Russian Association of Endocrinologists on prevention and treatment of vitamin D deficiency are an effective instrument in patients’ management. For prevention and treatment of vitamin D deficiency in obese patients higher doses of colecalciferol are required. In adult patients it is recommended to start correction of vitamin D deficiency (lower than 20 ng/ml) and insufficiency (20-29 ng/ml) with a saturating colecalciferol dose with further switch to the use of maintenance doses. Saturation can be conducted with the use of various therapy regimens.

The review aimed to provide information on main characteristics of calcium and phosphate metabolism, osteoporosis markers, genetic predictors of the disorder and their significance in clinical practice. Osteoporosis is a common problem of public healthcare that is often underestimated. The disorder is often diagnosed retrospectively after a fragility fracture. About 25% of fragility fractures are associated with secondary osteoporosis or with other causes of calcium and phosphorus metabolism disorders. Estimation of main indicators of calcium and phosphate metabolism: calcium and phosphorus is necessary for osteoporosis differential diagnosis. Markers of bone remodeling such as bone-specific alkaline phosphatase, osteocalcin, N-terminal propeptide of type 1 procollagen, and C-terminal telopeptide of type 1 collagen are important in dynamics assessment of osteoporosis treatment effectiveness and should be used more widely. The use of COL1A1, CALCR, VDR genes polymorphisms analysis for assessment of susceptibility to osteoporosis development is a question under consideration and requires further investigations. In order to write this review we analyzed Russian and foreign literature mostly published in the last 5 years and dedicated to the problem of osteoporosis. On the basis of literature study a deep understanding of specificities of the use of calcium and phosphate metabolism characteristics, osteoporosis markers and gene polymorphism in routine clinical practice was formed. Therefore, the presented material is quite practical for clinical physicians.

Primary aldosteronism is the most common cause of endocrine hypertension, occurring in 5-10% of patients with hypertension. Convincing evidence has been obtained indicating that primary aldosteronism increases the risk of cardiovascular complications, respectively, early diagnosis and treatment of patients with the definition of further tactics is a key step to prevent the progression of cardiovascular complications. The choice of the most appropriate treatment method for patients with primary aldosteronism depends on the diagnosis of nosological subtypes - bilateral adrenal hyperplasia (also known as idiopathic aldosteronism), which recommends a conservative treatment or unilateral aldosteronism due to aldosterone-producing adenoma, in which surgical treatment (adrenalectomy) is the tactic of choice. In addition, the "obvious" adrenal adenomas may in fact turn out to be areas of focal hyperplasia - a diagnostic error in this case leads to the unreasonable implementation of adrenalectomy. In order to clarify the lateralization of aldosterone hyperproduction, adrenal venous sampling is used. However, this method requires constant radiography, qualified endovascular surgery and is carried out in centralized medical hospitals. In this clinical case, we want to demonstrate the importance of a diagnosis of primary aldosteronism step by step.