Background. The prevalence of metabolic syndrome (MS) among people with type 1 diabetes mellitus (T1DM) varies widely depending on the criteria used and ranges from 6.4 to 57%. The relevance of studying the MS in T1DM is caused by the high risk of developing of micro and macrovascular complications. The current criteria for MS and the controversy over the inclusion of T1DM as a criterion do not provide reliability in diagnosing MS in this disease.

The aim. To assess the prevalence of MS in adults with T1DM and its impact on the course of the disease.

Materials and methods. A total of 134 patients over the age of 18 years were studied, including 67 (50%) men and 67 (50%) women. The median age was 33[19; 43] years, the median duration of diabetes was 13 [4; 27] years. MS was assessed according to the criteria of the 2009 Joint Interim Statement (JIS).

Results. MS was detected in 34 (25.4%) patients. The number of patients who did not have other criteria for MS except for T1DM was 57 (42.5%), 43 (32.1%) patients had 2 components of MS (one of the components in all was diabetes). Waist circumference >94 cm in men and > 80 cm in women, as well as blood pressure > 130 and 85 mm Hg were the most common components of MS (73.5 and 70.6% respectively). The insulin sensitivity coefficient was significantly lower in the group of people with MS (p=0.012). In patients with MS, only diabetic nephropathy was significantly more common (p = 0.019), while the differences in the frequency of retinopathy and neuropathy were statistically insignificant.

Conclusion. MS is a common condition in T1DM, which is based on insulin resistance. Presence of MS is associated with a risk of developing of diabetic nephropathy.

The aim. Study of the features of hormonal regulation of carbohydrate metabolism in men with type 2 diabetes mellitus (T2DM) and hypogonadism by assessing beta and alpha cell function, as well as the degree of insulin resistance (IR).

Material and methods. The study included 271 men with T2DM. Group 1 consisted of patients with T2DM and confirmed hypogonadism (n=126), group 2 consisted of men with T2DM without hypogonadism (n=145). Body mass index, waist circumference, hip circumference, fasting plasma glucose, glycated hemoglobin, triglycerides (TG), insulin, C-peptide, glucagon, HOMA-IR, HOMA-β, TYG indices were evaluated.

Results. In patients with hypogonadism, IR tended to be higher according to the HOMA-IR index (Δ0.41, p=0.07), and significantly higher according to the TYG index (Δ0.14, p <0.05). Also, in group 1, the TG level was higher (Δ0.33, p <0.05), higher values of C-peptide (Δ0.4 ng/ml, p <0.05), insulin (Δ3.3 mIU/ml, p <0.05) and HOMA-β index (Δ15.7 or higher by 84%, p <0.001). A moderate negative correlation was observed between the total testosterone level and the TYG index (r=-0.364, p <0.001). In group 1, the median glucagon was significantly lower – 46 versus 98.6 pg/ml (p <0.05). All men from group 1 who had their basal glucagon levels assessed had values of less than 150 pg/ml.

Conclusion: The presence of functional hypogonadism in men with T2DM is associated with a more pronounced IR. The significant difference between the values of the TYG index and TG level, as well as the inverse correlation between total testosterone level and the TYG index, confirm that hypogonadism in T2DM in men can be considered as an independent cardiovascular risk factor. T2DM in men with functional hypogonadism is characterized by the absence of basal hyperglucagonemia.

The new cardio-reno-metabolic strategy in the monitoring and treatment of patients with type 2 diabetes mellitus (T2DM) obliges the clinician to increasingly prefer early combination therapy, which provides not only reliable and safe glycemic control, but also protection against cardio-renal complications of T2DM. The drugs that meet these requirements are sodium-glucose cotransporter type 2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists, which have shown not only a high efficacy and safety profile, but also a reduced risk of major cardiovascular diseases, chronic kidney disease and mortality. Moreover, it is currently known that the pleiotropic effects of these drugs are not limited to cardio-renal protection. This article discusses the latest data on the effects of GLP-1 receptor agonists, which open up completely unexpected prospects for the use of these drugs, such as the treatment of heart failure, non-alcoholic fatty liver disease, steatohepatitis and neurodegenerative diseases.

Magnetic resonance focused ultrasound therapy is a noninvasive method for treating central nervous system diseases such as Parkinson's disease, essential tremor, and dystonia. The method is limited by poor ultrasound conductivity of the cranial bones. The objective of this review is to study the relationship between phosphorus-calcium metabolism and cranial bone density. A literature review has shown that patients with the diseases of central nervous system often have vitamin D deficiency, parathyroid diseases, and osteoporosis. The main parameters of ultrasound conductivity of the cranial bones depend on the density, thickness, and homogeneity of the bones, in the formation of which phosphorus-calcium metabolism is involved. The use of bisphosphonates, such as alendronate, to increase bone density and remove limitations for focused ultrasound is promising.

Currently, dipeptidyl peptidase-4 inhibitors (gliptins) consistently occupy an increasingly important place in the arsenal of endocrinologists worldwide and are considered one of the most promising classes of hypoglycemic agents. According to the results of numerous studies among representatives of this group, vildagliptin demonstrates the greatest efficacy and safety in the treatment of type 2 diabetes mellitus, which, in addition to its sugar-lowering effect, has a positive effect on the cardiovascular system in the long term, has a beneficial effect on blood pressure, exhibits cardioprotective properties, is well tolerated by patients and has a low risk of hypoglycemia. These characteristics allow us to recommend vildagliptin for the treatment of patients with a wide range of comorbidities, including the elderly and senile.

Background. Metabolic disorders are highly prevalent in women of reproductive age, but their potential impact on fertility has been understudied and the importance of metabolic status for fertility remains underestimated.

The aim. To assess the impact of metabolic risk factors on female fertility and to identify strategies for improving infertility treatment.

Material and methods. The analysis included 40 studies (systematic reviews and meta-analyses, randomized controlled trials, and cohort studies for Russian-language studies).

Results. Metabolic disorders, including hypertension, hyperglycemia, dyslipidemia, and obesity, account for up to 40% of observations among women of reproductive age. The mechanisms of their impact on fertility depend on the type of disorder but have a common feature - insulin resistance. The mechanisms of insulin resistance influence on the risk of female infertility include disruption of energy metabolism, activation of oxidative stress and effects on hormone secretion and endometrial receptivity, oocyte development, quality and implantation of embryos. Among the gynecological diseases associated with metabolic disorders and decreased fertility, the most common are endometriosis, anovulation and polycystic ovary syndrome (PCOS). In the treatment of infertility associated with obesity and PCOS, lifestyle changes (diet, physical activity, sleep, stress reduction) and drug therapy (insulin sensitizers) are considered. An alternative approach that offers the use of inositol (a combination of myo- and D-chiroinositol with folic acid and manganese) deserves attention.

Conclusion. Overweight and insulin resistance are the most significant metabolic abnormalities in the pathogenesis of female infertility. A complex containing a combination of myo- and D-chiroinositol with a vitamin-mineral premix shows positive results in improving the metabolic profile and restoring fertility.

Prediabetes is a clinical condition characterized by impaired glucose tolerance, insulin resistance, and an increased risk of developing type 2 diabetes mellitus. In addition to its progression to diabetes, prediabetes is an independent risk factor for cardiovascular diseases (CVD) due to a complex of pathophysiological mechanisms, including endothelial dysfunction, chronic inflammation, and lipid metabolism disorders. Moreover, the presence of CVD itself can contribute to worsening insulin sensitivity, thereby increasing the likelihood of developing prediabetes. This article presents current data on the epidemiology, pathogenesis, diagnostic methods, and pharmacotherapy of prediabetes, along with a comparative analysis of pharmacological approaches, including Subetta^®, metformin and GLP-1 receptor agonists.

Chronic kidney disease (CKD) is one of the most common complications of type 2 diabetes mellitus. Currently, in addition to the classic CKD phenotype, three alternative phenotypes of CKD in diabetes are known, which are characterized by regression of albuminuria, a rapid decrease in SCF or “non-albuminuric” CKD. Inflammatory and fibrotic lesions of various structures in the kidneys due to diabetes determine the multiplicity and unpredictability of the trajectories of CKD progression and do not allow predicting the final version of its course. In addition, cohort studies have shown that the risks of developing kidney disease and cardiovascular disease may vary depending on the CKD phenotype. A better understanding of the clinical course of CKD in diabetes mellitus is critical to improve risk stratification and enable early initiation of drugs that slow the progression of CKD, such as SGLT-2 inhibitors, RAAS inhibitors and mineralocorticoid receptor antagonists.

In recent years, significant progress has been made in glucose monitoring technologies, which allow patients with type 2 diabetes mellitus (T2DM) to more accurately monitor glucose levels and respond quickly to changes. The use of new technologies in the treatment of T2DM, including flash monitoring of glycemia (FMG), helps to select the appropriate hypoglycemic therapy for a particular patient, as well as motivate them to lifestyle changes. In the presented clinical case, a patient with T2DM received basic bolus insulin therapy, however, against its background, compensation for carbohydrate metabolism was not achieved. To assess the causes of hyperglycemia, select and optimize hypoglycemic therapy, as well as motivate the patient to treat diabetes, an FMG system was installed for the patient. Against the background of monitoring, the patient began to calculate the dose of ultrashort-acting insulin, taking into account the bread units consumed, changed his diet, which allowed him to reach the target glucose values as soon as possible, after which the ultrashort-acting insulin was discontinued and metformin was added to therapy. Thus, the patient's commitment to therapy and lifestyle changes during FMG helped to achieve compensation for T2DM. This clinical case demonstrates the importance of using modern glucose monitoring technologies, as well as a combination of various treatment methods to achieve target blood glucose levels in patients with T2DM.

Mucormycosis is an aggressive fungal infection caused by fungi of the class Mucorales. It is rare, leading to diagnostic errors. Recently, cases of mucormycosis have been reported in the background of COVID-19. Our experience in the diagnosis and treatment of this disease, reflected in the presented clinical case, may be useful to endocrinologists and doctors of other specialties.

Primary hyperparathyroidism is an endocrine disease characterized by persistent disturbance of phosphorus-calcium metabolism due to primary pathology of the parathyroid glands. Surgical treatment is the only method that allows achieving persistent remission of the disease and preventing the development of symptoms associated with hypercalcemia, improving the condition of bone tissue and kidneys. Conservative treatment does not allow achieving an equal effect. There are isolated cases of spontaneous remission of primary hyperparathyroidism after drug therapy in medical reviews. This article presents a case of long-term observation of a patient with primary hyperparathyroidism, who achieved persistent remission against the background of conservative treatment. Phosphorus-calcium metabolism and parathyroid hormone levels normalized, densitometry indicators improved, and parathyroid gland formations regressed. The period of remission of primary hyperparathyroidism is more than 30 months.