The aim: to evaluate the effect of dulaglutide on metabolic markers and body composition in patients with type 2 diabetes mellitus (T2DM) and obesity.

Material and methods. A randomized interventional study was conducted. The study involved: a study group of 57 people with T2DM, obesity of varying severity, who added dulaglutide 1.5 mg once a week to metformin therapy. The control group consisted of 53 patients on metformin monotherapy at a dose of 1.5–2.0/day. All patients underwent an examination at the beginning and after a year of therapy, which included the determination of glycemic control parameters (glycated hemoglobin, fasting blood glucose), anthropometric parameters (body weight, body mass index (BMI), waist circumference (WC)), irisin, highly sensitive C-reactive protein (HCRP), body composition with using bioimpedance measurement.

Results. After one year of therapy, the addition of dulaglutide led to a statistically significant decrease in the level of glycated hemoglobin from 7.2 [6.5; 9.3] to 6.5 [6.2; 8.4] % (p <0.05), body weight – from 109 [93–131] to 105 [65–129] kg (p <0.05), BMI – from 39.2 to 37.05 kg/m² (p <0.05), WC – from 125 [115–135] to 119 [91–127] cm (p <0.05). In addition, the addition of dulaglutide to therapy led to a statistically significant increase in irisin from 4.01 [2.39–6.73] to 5.33 [1.46–8.38] ng/ml (p <0.05), there was also a significant decrease in HCRP, a decrease in adipose tissue mass according to the results of bioimpedance.

Conclusion. The intensification of therapy by adding dulaglutide once a week to metformin therapy in patients with T2DM and obesity contributed to a statistically significant improvement in glycemic control, a marker of inflammation, increased irisin, and a decrease in the amount of adipose tissue, while there was no decrease in musculoskeletal mass.

Type 2 diabetes mellitus (T2DM) and obesity are two of the most common metabolic pandemics in the modern world. They have a significant impact on the incidence, mortality, and quality of life of populations. Currently, one of the promising pathogenetic mechanisms for metabolic disorders is a defect in incretin response. This defect is observed not only in T2DM, but also in obesity. Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are the main incretins that exert systemic regulatory effects on various organs and systems. These peptides have a number of characteristics that determine their physiological effects and therapeutic potential. The last decades have seen the development and introduction of innovative incretin-based sugar-lowering medications, among which tirzepatide occupies a special place. It is the first dual agonist for GLP-1 and GIP receptors to be approved in May 2022, marking the beginning of a new era in treating metabolic diseases. Informally known as twinkretin, this drug demonstrates outstanding efficacy in both glycemic management and weight loss, making it an effective tool for integrated treatment of T2DM and obesity, as well as reducing cardiometabolic risk factors

The aim of the review is to analyze the system of complex anthropometric research in clinical practice. Fundamental non-periodical literature on anthropometry and dietetics was studied, a search for scientific publications was carried out using the library platforms eLIBRARY, PubMed, Elsevier using the keywords anthropometry, body composition, obesity, sarcopenia, bioimpedancemetry. The article presents from a modern standpoint the current methods for assessing the physical development of a person, used in clinical practice to study the nutritional status of a person, assess the risks of development and prevention of alimentary-dependent diseases, as well as used in the process of diet therapy of patients who need medical care in the profile of “Dietetics”. The system of complex anthropometric research in clinical practice is presented. This system in clinical practice is applicable in many areas of medicine and allows systematizing the diversity of anthropometric studies to assess the nutritional status of a person.

Liver damage can occur in diabetes mellitus, not only type 1 (T1DM), but also type 2 (T2DM). It can be confidently stated that there is a mutual pathogenetic relationship between T2DM and metabolic-associated fatty liver disease (MAFLD). MAFLD acts as an independent pathogenetic factor in the progression of cardiovascular, renal, and oncological diseases. Three variants of liver pathology have been described in patients with T1DM: MAFLD, glycogen hepatopathy, and diabetic hepatosclerosis, while the latter two may be pathognomonic for this type of diabetes. The representation of practitioners about the options for liver damage in diabetes makes it possible to effectively control risk factors and avoid prescribing unjustified studies and ineffective medications.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are a relatively new class of sugar-lowering drugs characterized by a favorable safety profile and  a neutral effect on body weight. They are characterized by low incidence of side effects and good tolerability, even in patients with endstage chronic kidney disease. Preclinical and clinical studies have shown that these drugs have a wide range of pleiotropic effects on the cardiovascular and central nervous systems, and other organs. One key mechanism explaining the cardioprotective properties of DPP-4 inhibitors is their anti-inflammatory effect. The use of these drugs has been associated with decreased systemic markers of inflammation such as C-reactive protein and pro-inflammatory cytokines, potentially reducing the risk of atherosclerosis and its complications. In addition, DPP-4 inhibitors improve endothelial function by increasing the bioavailability of nitric oxide and reducing the adhesion of leukocytes to the vascular wall, which contributes to vasodilation and reduces the likelihood of vascular complications. This review provides basic information about DPP-4 inhibitors, examines the clinical prospects for its use, and substantiates the benefits of combination therapy as well as the main pleiotropic effects on the cardiovascular system and brain.

Hypothyroidism is a clinical syndrome resulting from decreased thyroid function, manifested by decreased thyroid hormone levels in the blood. The incidence of hypothyroidism varies by gender and age. This article examines the key causes of primary and secondary hypothyroidism. The main factor causing primary hypothyroidism is autoimmune thyroiditis, which can occur in isolation or in combination with other autoimmune pathologies. The severity of clinical manifestations depends on the degree of thyroid hormone deficiency. The symptoms of hypothyroidism are described in detail, with an emphasis on pathological changes in the cardiovascular system. Hypothyroidism is most common in elderly patients and the elderly, who are characterized by a vague clinical picture. Special attention is given to the difficulties of diagnosing hypothyroidism, which sometimes masquerades as symptoms of other diseases. Confirmation of the diagnosis requires a range of laboratory and instrumental studies. Hypothyroidism, regardless of its cause, is treated with sodium levothyroxine (L-T4) replacement therapy. Recommendations for optimizing treatment approaches for thyroid insufficiency are provided.

Impaired effects of incretin hormones are the leading cause of type 2 diabetes mellitus (T2DM) and obesity. Currently, the most effective groups of drugs for the treatment of both T2DM and obesity are glucagon-like peptide-1 receptor agonists (semaglutide, liraglutide, etc.) and dual glucose-dependent insulinotropic polypeptide / glucagon-like peptide-1 receptor agonists (tirzepatide). Tirzepatide is the most effective in terms of glycemic control and weight loss, followed by semaglutide and liraglutide.

The intestinal microbiota is a complex and unique structure that includes tens of thousands of bacterial species and regulates many processes in the human body to maintain homeostasis. Cigarette smoke, being a source of exposure to toxic chemicals, causes a wide range of pathological processes associated with smoking, one of which is a change in the composition and structure of the intestinal microbiota, increased permeability of the mucous membrane and local inflammatory reactions. This review highlights the currently accumulated knowledge about the mechanisms of the influence of cigarette smoke on the intestinal microbiota, and also examines the concept of harm reduction from smoking, which offers a patient who is not motivated to quit smoking to switch to products that are less harmful than traditional cigarettes and have a reduced risk.

Currently, there is a rapid increase in the study of the relationship of the gut microbiota (GM) with the pharmacokinetics and pharmacodynamics of drugs, including hypoglycemic ones. The review describes possible mechanisms by which GM can influence the efficacy and safety of various hypoglycemic drugs (HDs). Moreover, intestinal bacteria affecting the pharmacokinetics of HDs are described. Despite the fact that data on the relationship of GM with the effectiveness and development of side effects of HDs are sharply limited, using the example of metformin, it was determined that the presence in GM of a high number of Short-chain fatty acids (SCFAs) producers and genera associated with bile acid metabolism is associated with high drug efficacy and the development of side effects. The fact is that SCFAs and primary bile acids are triggers for the secretion of glucagon-like peptide-1, which, on the one hand, contributes to the improvement of glycemic indices through the incretin effect and the operation of the “intestine – brain – perif” mechanism.

Hypothyroidism, characterized by a deficiency of thyroid hormones, is a common endocrine pathology in women of reproductive age, which is a significant problem during pregnancy. Insufficient thyroid function has a negative impact on maternal health and fetal development, increasing the risk of gestational hypertension, premature birth, placental abruption and impaired neurocognitive development of offspring. Timely diagnosis and adequate hormone replacement therapy play a key role in preventing adverse outcomes. The article provides an overview of current data on the pathogenesis, diagnosis, and treatment of hypothyroidism during pregnancy, including screening issues, target levels of thyroid-stimulating hormone, and features of interpretation of laboratory parameters. Special attention is paid to the choice of the optimal form of levothyroxine, which is the first-line drug for hormone replacement therapy of hypothyroidism. The potential advantages of using the liquid form of levothyroxine, characterized by improved absorption, minimizing the influence of factors that reduce bioavailability, and the possibility of accurate dosage, which is especially important in conditions of physiological changes occurring in the body of a pregnant woman, are considered.

Neuroendocrine tumors are a rare pathology that includes highly differentiated neoplasms from cells of the neuroendocrine system that have the ability to secrete biologically active substances. In 5% of cases, the development of neuroendocrine tumors is associated with the hereditary syndrome of multiple endocrine neoplasia (MEN). The purpose of the article is to demonstrate a clinical case of a patient with type 2a MEN syndrome. А feature of this clinical case is the recurrent course of malignant pheochromocytoma. A theoretical reference is also provided based on current clinical recommendations for the management of patients with neuroendocrine formations

The article presents a case of diagnosis and management of a patient with diabetes mellitus (DM) associated with pathology of the exocrine pancreas (DEP). The patient had a 19-year history of DEP. The cause of diabetes in this patient was a long-standing (over 25 years) chronic pancreatitis (CP). At the time of hospitalization, the patient’s C-peptide level was 0.34 ng/mL. The presence of exocrine pancreatic insufficiency was confirmed by fecal elastase-1 testing, which showed a value of 10.86 μg/g. Abdominal ultrasound (US) did not reveal specific pancreatic changes typical for CP, whereas magnetic resonance imaging detected cysts in the tail region of the pancreas. This finding highlights the low sensitivity of US for diagnosing CP, which is one of the causes of diabetes. The patient had been on long-term pancreatic enzyme replacement therapy at a dose of 10,000 units of lipase per meal and reported no complaints of exocrine insufficiency. Basal-bolus insulin therapy was used to compensate for carbohydrate metabolism disturbances. Continuous glucose monitoring with the FreeStyle Libre 2 system showed an average glucose level of 9 mmol/L, a glycemic variability of 23.6%, and no episodes of hypoglycemia were recorded. This observation emphasizes the limited utility of US in diagnosing DEP. Patients with DEP require not only hypoglycemic therapy but also enzyme replacement therapy to eliminate symptoms of exocrine pancreatic insufficiency and prevent hypoglycemia. The use of modern methods of glycemic control allows improving patients’ quality of life and enhancing the effectiveness of treatment.