Background. Cardio-reno-metabolic health is a modern interdisciplinary concept reflecting the relationship between metabolic disorders, kidney diseases and the cardiovascular system. This relationship plays a key role in the development of a number of socially significant diseases and their complications.
The aim: to determine the role of chronic kidney disease (CKD) in the development of atherosclerotic cardiovascular diseases (CVD) in patients with type 2 diabetes mellitus (T2DM).
Materials and methods. The study included 100 patients with T2DM who were hospitalized in the Department of Endocrinology of the V.P. Demikhov State Clinical Hospital from 09/01/24 to 11/30/24. All patients underwent a comprehensive examination: assessment of anthropometric indicators, laboratory parameters, and instrumental examination methods. The patients were divided into two groups. The first group included 37 patients with confirmed CKD (GFR according to the CKD-EPI formula <60 ml/min/1.73 m2), the second group included 63 patients without CKD (GFR according to the CKD-EPI formula >60 ml/min/1.73 m2). The initial information was systematized and the results visualized in Microsoft Office Excel 2016 spreadsheets. Statistical analysis was performed in Jamovi programs.
Results. The average age of patients was 68.56±7.3 years (95% CI: 50-89), the average length of T2DM was 12.05±8.14 years (95% CI: 3-42). The average level of glycated hemoglobin (HbA1c) was 8.9±2.14 % (95% CI: 5.5-15.1). In group 1 (n=37), cardiovascular complications occurred in 25 people (67.56%). In group 2 (n=63), complications were observed in 29 people (46%). All the studied complications were more common in group 1: acute myocardial infarction was more common by 1.8%, stroke by 11%, arterial diseases of lower extremities by 6.5%, chronic heart failure by 18.1%. Two or more cardiovascular complications were more common in group 1 by 13.2% (p= 0.024, according to Pearson's chi-squared criterion).
Conclusion. The study revealed significant differences in cardio-metabolic characteristics in patients with T2DM, depending on the presence or absence of CKD. In patients with T2DM and CKD (group 1), cardiovascular complications were significantly more common (67.56%) than in patients without CKD (46%). This suggests that CKD is an independent risk factor for developing CVD in patients with T2DM.

Background. Arterial hypertension (AH) in obese patients is often masked (hidden) and is manifested by an increase in blood pressure (BP) at night, which makes it difficult to with office blood pressure measurement. Ambulatory blood pressure monitoring (ABPM) is an effective tool for diagnosing hypertension and evaluating the effectiveness of treatment in obese patients.
The aim: to identify the features of the hypertension profile according to the ABPM data in obese young male patients.
Materials and methods. A prospective observational study was conducted, which included 102 male patients with hypertension and obesity who were hospitalized in the endocrinology department of the V.P. Demikhov State Clinical Hospital.
Results. The median age of the patients was 23 [21; 25] years; body mass index (BMI) 40 [32; 53] kg/m2. The patients did not receive antihypertensive therapy. In the groups of patients with grade 2 and 3 obesity, the median daily averages were 125.00 [105.50; 131.00] and 129.00 [120.50; 136.50] mmHg, respectively, for SBP (p=0.180) and 80.00 [75.00; 89.00] and 81.00 [73.50; 89.75] mmHg for DBP (p=0.937). 31.4% (n=32) of patients are of the "dipper" type, 52.9% (n=54) are "non-dippers", 8.8% (n=9) are "night pickers", 6.9% (n=7) "over-dippers". The median BMI in these groups was as follows: 39.45 [37.08; 42.40], 40.60 [38.35; 41.65], 39.40 [37.80; 39.90] and 40.10 [39.75; 45.25] kg/m2, respectively.
Conclusions. Most patients are classified as "non-dippers", that is, they have an insufficient decrease in blood pressure at night, in addition, more than half of the patients have nocturnal hypertension, which is a risk factor for adverse cardiovascular outcomes.

Diabetes mellitus (DM) and chronic heart failure (CHF) are becoming epidemics of the 21st century. These conditions mutually aggravate each other and have a close pathophysiological relationship. Diabetes has a significant impact on the prognosis of individuals with various types of heart failure, which creates enormous clinical and economic difficulties. Diabetes mellitus (DM) and chronic heart failure (CHF) are becoming epidemics of the 21st century. These conditions mutually aggravate each other and have a close pathophysiological relationship. Diabetes has a significant impact on the prognosis of individuals with various types of heart failure, which creates enormous clinical and economic difficulties.

Despite significant advances in the treatment of cardiovascular diseases (CVD) over the past two decades, they remain the leading cause of death worldwide. Type 2 diabetes mellitus (T2DM) and prediabetes are widespread among people with CVD and are associated with adverse outcomes. The widespread occurrence of carbohydrate disorders in the population is mainly associated with the development of insulin resistance (IR), which is most often the earliest defect formed at the earliest stages of cardiorenometabolic syndrome. Meta-analyses of observational studies have shown that middle-aged adults with prediabetes have an increased risk of atherosclerotic cardiovascular disease (ARVD), heart failure, and all-cause mortality. According to the latest data, in a 30-year risk analysis, prediabetes was moderately associated with the risk of complications such as CVD, chronic heart failure, chronic kidney disease, and all-cause mortality, compared with normoglycemia. This association remained significant even after taking into account the progression to T2DM (HR 1.18; 95% CI: 1.12–1.24), and 85% (95% CI: 75–94%) of the excess risk of developing any complications with prediabetes remained. That is, the progression of T2DM explains less than a quarter of the risks of clinical outcomes associated with prediabetes. In other words, prediabetes contributes to the risk of adverse clinical outcomes even without T2DM progression. And complex therapy aimed at correcting IR can ensure better compensation and prevent the development of a cascade of cardiometabolic disorders. This review will focus on the role of IR and prediabetes in the development of CVD and the long-term benefits of timely diagnosis and therapy of early carbohydrate metabolism disorders.

Despite a comprehensive study of such comorbidities as cardiovascular diseases and diabetes mellitus (DM), the pathogenetic mechanisms and clinical course of cardiac arrhythmias in this pathology require more detailed research. Cardiac arrhythmias are the leading cause of sudden cardiac death in patients with diabetes, presenting a serious clinical problem. The pathogenesis of arrhythmias in DM is complex and multifaceted. Numerous risk factors, including chronic hyperglycemia, create a background for structural remodeling of the myocardium, which is an early marker of heart muscle dysfunction. Concurrently, dysregulation of the autonomic nervous system leads to significant changes in the electrical activity of the heart and causes rhythm disorders. The variety of arrhythmias, including supraventricular and ventricular arrhythmias as well as bradyarrhythmias, creates significant diagnostic and therapeutic challenges for medical professionals and necessitates an integrated approach to diagnosing this category of patients. Understanding the mechanisms of arrhythmia development in DM is crucial for their effective prevention and treatment. This review examines the pathophysiological mechanisms underlying arrhythmias in DM and identifies the main therapeutic goals for reducing the risk of sudden cardiac death.

Type 2 diabetes mellitus (T2DM) is a multifactorial disease that is an independent risk factor for severe cardiovascular prognosis. Along with T2DM, obesity is also recognized as one of the most important risk factors for cardiovascular diseases (CVD), the prevalence of which has reached epidemic proportions. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are an innovative class of hypoglycemic drugs that affect not only metabolic disorders, but also various tissues and organs. Representatives of the incretin family of GLP-1 RA have unique pleiotropic effects, an extensive evidence base, high metabolic efficiency and safety. The article provides a detailed review of clinical studies conducted with this group of hypoglycemic drugs. Semaglutide deserves special attention among the GLP-1 RA drugs, which showed excellent results in large randomized clinical trials not only in terms of glycemic control and weight loss, but also cardio- and nephroprotective properties compared to other drugs of this class. At present, semaglutide is the first GLP-1 RA that demonstrated a favorable effect on the main endpoints of major adverse cardiovascular events (MACE), the course and risk of atherosclerotic CVD and chronic heart failure in both patients with T2DM and in patients with obesity. This allows the drug to be used not only for the treatment of T2DM, but also for the treatment of obesity and reduction of the risk of CVD. Thus, the improvement in the quality of life of patients with both metabolic disorders and CVD during GLP-1 RA therapy opens up new horizons for the use of these drugs in various fields of medicine.

Arterial hypertension (AH) is one of the most common comorbidities in patients with diabetes mellitus (DM), significantly increasing the risk of adverse outcomes and cardiovascular complications. The coexistence of these conditions is driven by shared pathophysiological mechanisms of metabolic disorders, as well as hereditary and acquired factors. Frequent coexistence of AH and DM requires certain principles of patient management and control. Blood pressure (BP) control, along with control of glycemia and lipid profile parameters, is one of the most important components of complex therapy of DM and its complications. The question of at what BP values it is necessary to initiate therapy and what should be the target BP values in patients with diabetes has been controversial for many years. Another issue requiring attention is the management of “prehypertension” or high normal BP in patients with DM. In this article, we will review the main benefits and risks of intensive BP control in patients with diabetes, as well as strategies for managing patients with prehypertension according to current clinical guidelines and the latest research data.

In modern diabetology, there is a growing interest in patient-reported outcomes (COI) as an important indicator influencing the effectiveness of therapy. This review analyzes the effect of de-intensification of complex insulin therapy regimens using the drug Iglarlixi (a combination of insulin glargine 100 U/ml and lixisenatide) on the quality of life and satisfaction with treatment in patients with type 2 diabetes mellitus (T2DM). The results of key studies (SoliSwitch, IDEAL, SIMPLIFY Japan) are reviewed, demonstrating a significant improvement in COI indicators when switching from multiple injections of insulin or ready-made mixtures to a single injection of Iglarlixi. The most pronounced improvements were noted in the domains “Burden of treatment” and “Diabetes management”. Given the influence of psychosocial factors on the perception of therapy and treatment adherence, de-intensification of insulin therapy may be especially important for patients experiencing stigmatization and diabetic distress. The review results confirm that switching to Iglarlixi is an effective de-intensification strategy that improves both glycemic control and quality of life in patients with T2DM.

Non-alcoholic fatty liver disease (NAFLD) is a chronic metabolic disease in individuals with no exogenous factors of toxic liver damage caused by the accumulation of lipids in the cellular elements that make up the liver lobule. NAFLD is a rapidly growing global health problem associated with increased morbidity and mortality. In recent years, the close relationship between NAFLD and cardiometabolic diseases has been emphasized, which is related to the common pathogenetic mechanisms of their development. Weight loss and lifestyle changes are the mainstay of treatment, but in most cases there is a need to introduce pharmacological therapy strategies. This review presents current data on epidemiology, pathophysiological aspects of the development and treatment of NAFLD, examines the relationship of hypertriglyceridemia in the development of NAFLD and the possibility of complex lipid-lowering therapy in improving the course of liver dysfunction.

The article presents a clinical case of detection of subacute thyroiditis (PT) during an outpatient examination of a 34-year-old male patient with suspected acute respiratory viral infection. The patient went to the doctor complaining of a respiratory infection: fever, weakness, decreased appetite, sweating. During a physical examination, the doctor revealed pain on palpation in the area of the thyroid cartilage, which led to an additional examination of the patient for thyroid disease. According to the results of laboratory data, the level of free hormone T4 was 52 pmol/l, C-reactive protein was 71.53 mg/l. According to ultrasound examination of the thyroid gland, signs of diffuse thyroid changes by type of thyroiditis were revealed. The node of the left lobe (Tirads-3). Upon further examination, an endocrinologist diagnosed subacute thyroiditis. This observation illustrates the importance of a detailed medical history collection by a primary care physician in patients with subfebrility, who tend to selectively express complaints as part of their vision of the disease, interpreting fever as a sign of an infectious disease, and also emphasizes the importance of objective physical examination of all organs and systems, including thyroid palpation, and the appointment of additional research methods (assessment markers of inflammation), taking into account possible non-infectious causes of these symptoms.

The urgency of the problem of type 1 diabetes mellitus (T1DM) does not lose ground over time due to the peculiarities of the course of the disease, the need for radical lifestyle correction, which leads to a decrease in the quality of life of patients, as well as a high probability of early disability and mortality of patients at a young age. Unsatisfactory glycemic control in T1DM is closely interrelated with both the risk of rapid development of chronic complications and the likelihood of acute complications. Achieving optimal glycemic control during insulin therapy requires frequent monitoring of glycemia, a detailed understanding of the rules for counting bread units, the ability to recognize and stop hypoglycemia at early stages, as well as the ability to adapt the administration of insulin to various life situations. With the advent of pump insulin therapy, some of these factors stopped to cause inconvenience to patients, however, even with pump insulin therapy, patients still need frequent monitoring of glycemia, self-administration of bolus insulin with counting bread units, as well as correction of insulin administration manually if necessary. The use of a closed loop system is highly promising in terms of improving the quality of life of patients with T1DM. This project is a semblance of a healthy pancreas. The goal is to maintain normoglycemia or blood glucose levels in a set range by automatically adjusting the basal and bolus insulin secretion rates using a pump. The adjustment of insulin secretion by the pump is carried out in accordance with the indications of the continuous glucose monitoring system. We present a clinical case of using this system by a patient with T1DM.