All over the world, the number of patients suffering from type 2 diabetes mellitus, non-alcoholic fatty liver disease and cardiovascular diseases is increasing every day. At the same time, they not only coexist as independent diseases, but also have many points of intersection in pathogenesis and progression, such as dyslipidemia, prothrombotic processes, insulin resistance and hyperglycemia, chronic subclinical inflammation. Thus, they make each other’s course heavier and increase the number of adverse outcomes, including general and cardiovascular mortality. All this is an incentive for a more detailed study of the complex relationship of these diseases, in order to optimize diagnostics and treatment. Due to the urgency of this issue, the effect of most of the currently existing hypoglycemic drugs on non-alcoholic fatty liver disease and cardiovascular diseases has already been reflected in many studies and meta-analyses. This review will cover the main groups of drugs, namely biguanides, thiazolidinediones, sodium-glucose cotransporter type 2 inhibitors, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists. The use of which is approved in comorbid patients according to these conditions pathogenesis.

The article discusses the modern approaches to a glycemic control among outpatients with prediabetes. The risk factors for prediabetes, the possibilities of its screening, and the issues of treatment non-adherence are discussed. An attention is paid to the aspects of teaching patients the skills of competent self-monitoring of glycemia, and the use of glucometers integrated with smartphones at home. Modern features and advantages of the glucometer for self-control over the disease are discussed.

SGLT-2 inhibitors first emerged as a new class of oral hypoglycemic drugs with modest efficacy in lowering HbA 1c levels, which were also capable of inducing weight loss and lowering blood pressure without a significant risk of hypoglycemia. However, an analysis of the results of studies conducted to assess cardiovascular outcomes in patients with type 2 diabetes mellitus (DM) during iSGLT-2 therapy showed evidence of nephroprotection, which led to the initiation of trials on renal outcomes. The data obtained showed that the protective effects of iSGLT-2 against cardiovascular and renal complications of type 2 diabetes do not directly depend on their hypoglycemic activity, while their particular clinical significance is demonstrated in reducing the risk of hospitalization for heart failure (HF), progression of diabetic kidney disease (RDK), as well as a reduction in the incidence of major adverse cardiovascular events (MACE).

Today it is known that against the background of diabetic nephropathy, cardiovascular consequences become more serious. CKD patients with diabetes are more likely to die from cardiovascular causes than from end-stage renal disease. Diabetic kidney disease appears to be not only a marker of increased cardiovascular risk, but also involved in the pathogenesis of cardiovascular disease. An increase in traditional risk factors such as hypertension, hyperlipidemia, and obesity cannot fully explain the worse cardiovascular and fatal outcomes in CKD.

This review will focus on the role of iSGLT-2 in the outcomes of type 2 DM complicated by the development of CKD, and will highlight the putative mechanisms of the nephroprotective action of this group of drugs.

Adrenal insufficiency (AI) is a life-threatening disease characterized by a decrease in the production of hormones by the adrenal cortex and requires lifelong replacement therapy with glucocorticoids (GCs) and, in some cases, mineralocorticoids (MCs). The number of individuals with primary and secondary AI in Europe is estimated at 20-50 per 100 thousand people, the increase in the number of cases of this disease in the world may be partly due to the rapid increase in the frequency of use of GC in various clinical strategies, including in oncological diseases.

In AI, hormone replacement therapy is vital, but long-term use of GC may be associated with various adverse effects, especially at non-physiological concentrations of GC. This review provides a brief overview of the current therapeutic possibilities of AI hormone therapy, which contributes to the prevention of the development of adrenal crises, as well as promising opportunities for more effective imitation of the physiological profile of cortisol, aimed at preventing the development of undesirable effects of therapy. Several different forms of AI are currently available, differing in profile, duration of action, and route of administration. The most preferred currently in the treatment of AI are GCs with a short half-life, which provides a more manageable action profile and a lower risk of side effects. Promising substitution therapy options include modified-release hydrocortisone preparations, as well as new methods of drug administration using an insulin pump, which will better mimic the physiological effects of endogenous cortisol.

Hypercalcemia is a common laboratory finding. The most common causes of high blood calcium are primary hyperparathyroidism, tertiary hyperparathyroidism, parathyroid cancer, malignant neoplasms, long-term therapy with lithium and thiazide diuretics, vitamin D intoxication, which require a different approach to treatment. Therefore, it is important for a doctor to be able to conduct a differential diagnostic search for hypercalcemia syndrome in order to establish the cause of high blood calcium and determine the correct tactics for managing patients.

Hypoparathyroidism is a relatively rare endocrine disorder caused by the absence production of parathyroid hormone, leading to the classical biochemical features such as hypocalcaemia and hyperphosphataemia.

The data from Europe, the USA and Asian countries shows that the long course of chronic postsurgical and non-surgical hypoparathyroidism can lead to many complications from different organs and systems. Hypoparathyroidism increases the risk of kidney disease, including kidney failure, neuropsychiatric disorders and infections. The frequency and degree of disease complications depend on its etiology. Non-surgical hypoparathyroidism is associated with an increased risks of cataracts, cardiovascular diseases and vertebral fractures; however, the pathogenesis of these disorders is not fully understood. Various parameters of mineral homeostasis were discussed in the context of identified complications. For example, persistent hypercalciuria and intake of large doses of calcium and vitamin D supplements were associated with the structural pathology of the kidneys (nephrolithiasis, nephrocalcinosis).

This review covers the issue of the clinical manifestations and complications of chronic hypoparathyroidism, as well as predictors of their development.

Primary hyperparathyroidism (PHPT) is characterized by disorders of not only mineral metabolism, but also other kinds of the human metabolism. Due to the increased frequency of cardiovascular risk factors among patients with PHPT, the study of the carbohydrate metabolism pathology in this cohort of patients will allow developing optimal approaches to their timely diagnosis and treatment.

Aim. To determine the frequency and describe the clinical features of carbohydrate metabolism disorders in patients with PHPT.

Material and methods. A single-center retrospective study of adults with PHPT was carried out with an assessment of the main parameters of mineral and carbohydrate metabolism before surgical treatment of the disease. The exclusion criteria were the absence of PHPT remission or a recurrence of the disease after parathyroidectomy; pregnancy, lactation. The frequency of various disorders of carbohydrate metabolism in PHPT, the comparative characteristics of mineral parameters in patients with and without them, as well as the severity of type 2 diabetes mellitus in PHPT were determined. In addition, potential relationships between the parameters of various types of metabolism have been studied.

Results. The study was based on a clinical information of 367 patients with PHPT, most of whom had a symptomatic form of the disease. The overall incidence of prediabetic disorders was 4,9% (95% CI: 3-8). Type 2 diabetes mellitus was previously diagnosed in 45 patients (12%, 95% CI: 9-16), there were no cases of first diagnosed diabetes mellitus. Individuals with impaired carbohydrate metabolism had a statistically significantly higher body mass index and lower values of osteocalcin (27,2 [24,2; 30,4] kg/m² vs 32,7 [28,1; 39,4 kg/m² and 48,1 [34; 76,3] ng/mL vs 33,1 [20,8; 51,8] ng/mL, respectively, for all parameters p<0,001). Among patients with type 2 diabetes mellitus, 36 people (80%) took hypoglycemic therapy, 14 of which received metformin monotherapy and 8 received two-component therapy, including metformin. 5 people were on insulin therapy. Diabetic nephropathy was diagnosed in 36,4% of patients, 15,4% had signs of diabetic retinopathy, symptoms of diabetic distal neuropathy were observed in 61,9% of patients with PHPT. Fasting glucose and glycated hemoglobin were negatively correlated with bone metabolism, and also expectedly depended on the glomerular filtration rate.

Conclusion. Among patients with PHPT, type 2 diabetes mellitus is more common than in the general population. The likely reason of this may be insulin resistance, that can be caused by the effects of bone metabolites, primarily osteocalcin. In most cases, metformin makes it possible to achieve compensation for diabetes mellitus in PHPT.

Introduction. By 2023 it has been detected more than 600 million cases of COVID-19. One of the most significant risk factors for the severe course of a new coronavirus infection (NCVI) is the presence of comorbid diseases, especially the presence of diabetes mellitus (DM).

Aim. To investigate the laboratory and clinical features of a new coronavirus infection in people with diabetes mellitus, to identify predictors of an adverse outcome of COVID-19.

Material and methods. We carried out data from medical records of 248 patients treated in “Voronezh Clinical Emergency Hospital № 10” in the departments “COVID-5” and “COVID-8”. Data collection and statistical processing were performed with Microsoft Excel 10.0 and StatSoft STATISTICA 12.0 programs.

Results. The most frequent complaints of patients were general weakness, hyperthermia and dry cough. The analysis of the age characteristics revealed that the peak incidence of NCVI in hospitalized patients without DM falls on 70-79 years, with concomitant DM — on 60-69 years.

Among comorbid pathologies, hypertension, coronary heart disease and chronic heart failure prevailed. The presence of these diseases is a predictor of adverse outcomes in NCVI, along with cerebrovascular diseases and anemia.

Evaluation of laboratory data revealed the link of elevated levels of ferritin, C-reactive protein and D-dimer with an increased risk of death of NCVI.

Conclusion. Estimation the risk factors of a fatal outcome is crucial for the choice of patient treatment tactics.

The presented review describes a clinical case of a comorbid patient type 2 diabetes mellitus (T2DM), the severity of whose disease was due to the presence of COVID-19 infection suffered on the eve of hospitalization, as well as the presence of concomitant diseases from the cardiovascular and nervous systems. In the aggregate of simultaneously occurring pathological processes, a patient with type 2 diabetes had a picture of uncontrolled hyperglycemia. The lifeline for the comorbid patient was orientation towards a more effective triple combined hypoglycemic therapy consisting of a type 2 sodium-glucose cotransporter 2 inhibitor, a medcine from the aGLP-1 group and metformin.

Patients with multiple complications of diabetes mellitus often have significant deviations in the parameters of calcium-phosphorus and bone metabolism. The multifactorial nature of the pathogenesis of such disorders makes it difficult to manage patients with a long and complicated course of diabetes mellitus. This article describes a clinical case of a patient with a long history of type 1 diabetes mellitus, kidney transplantation as a result of terminal renal failure, and diabetic neuroosteoarthropathy. The features of vitamin D metabolism, the importance of timely diagnosis of phosphorus-calcium disorders and the features of patient therapy are discussed.

Klinefelter syndrome (KS) is a genetic disease associated with the presence of an extra X-chromosome in the karyotype of men. The most common karyotype is 47XXY, however, other genetic variants are also possible, as well as mosaic forms.

The clinical picture is most often represented by bilateral gynecomastia, decreased in the volume testicles and infertility (azoospermia). Laboratory revealed hypergonadotropic hypogonadism. Testosterone replacement therapy is used to ensure virilization and the proper quality of life. Assisted reproductive technologies with preliminary hormonal preparation are used to restore fertility.

This article presents a clinical case of KS and considers options for realization of reproductive plans in the case of non-obstructive azoospermia.