Introduction: Currently, the need to expand knowledge about the mechanisms of impaired immune tolerance in autoimmune adrenal insufficiency (AAI) remains relevant. It is not excluded that in AAI there are disturbances in the system of regulatory B-lymphocytes (Breg).

Objective: To assess the state of the B-regulatory cells system of immunity in AAI.

Material and methods: the content of Breg was evaluated in patients with AAI, including isolated AAI and AAI as part of autoimmune polyglandular syndrome type 2 (APS-2) and as part of APS-1, in patients with primary adrenal insufficiency (1-AI) of non-autoimmune genesis, conditionally healthy individuals without AI and autoimmune diseases.

Results: A decrease in the content of Breg in vivo was revealed in patients with isolated AAI and AAI in the composition of APS-2 compared with conditionally healthy participants. The content of Breg in vivo in patients with 1-AI of non-autoimmune genesis did not statistically differ from the indicators of conditionally healthy participants.

Conclusion: for the first time in the world, a tendency to a decrease in the content of Breg in AAI, caused by a disturbance of peripheral immune tolerance, was found. Thus, these cells can be considered as promising markers for the prognosis, early diagnosis, and differential diagnosis of AAI.

Clinical guidelines increasingly emphasize the importance of multifactorial treatment of type 2 diabetes (DM2), including both glycemic control and body weight control, comprehensive management of classical cardiological risk factors, as well as the use of drugs with proven cardionephroprotective effects to reduce the risk of long-term complications. The development of semaglutide, a long—acting and highly homologous receptor agonist of glucagon-like peptide-1 (arGPP-1) based on a widely recognized representative of the liraglutide class, was an important milestone in expanding the possibilities of disease management, and the successes achieved in the clinical research program of the drug contributed to the formation of the above aspects of the recommendations.

The clinical efficacy of semaglutide was evaluated in the framework of the SUSTAIN clinical research program for more than 10,000 patients with DM2. The program includes 6 major global studies of Phase IIIa (SUSTAIN 1-6) and 5 studies of phase IIIb (SUSTAIN 7-11), as well as a number of other studies and analyses.

The development of a domestic reproduced drug containing semaglutide will increase the availability of semaglutide preparations in the Russian Federation, as well as significantly more effectively control the level of glycemia in patients with DM2. This review presents the results of the efficacy and safety of semaglutide, including the Russian bioequivalent drug semaglutide.

Introduction. In the last few years gender and sex differences in type 2 diabetes (T2D) predisposition are paid much attention. This gap can be caused by the hormonal and genetic background and require further traits.

Aim. The aim of this study was to identify genetic markers of T2D predisposition depending on sex using 17 polymorphic markers of genes involved in various links of T2D pathogenesis.

Material and Methods. 536 patients with T2D and 1,476 healthy individuals were examined. Amplification of 17 polymorphic gene loci was performed by polymerase chain reaction. Associations of DNA polymorphisms with T2D were evaluated by logistic regression using the SNPStats program. The degree of association was assessed in the odds ratio (OR) scores. Correction for multiplicity of comparisons and multivariate analysis was used.

Results. The genotypes of increased T2D risk for men are CC of CCL20 rs6749704 marker (OR = 3.85, P = 0.0002) in recessive model, D/I of CCR5 rs333 marker (OR = 4.42, P = 0.0208); by GRIA1 marker rs2195450 - CT and TT in the dominant model (OR = 2.42, P = 0.0002), TT - in the recessive model (OR = 2.89, P = 0.0070). The genotypes of increased risk of T2D in women according to the marker TCF7L2 rs7903146 - CT and TT in the dominant model (OR = 1.69, P = 0.0003), TT - in recessive (OR = 1.61, P = 0.0124), according to the marker ADIPOQ rs17366743 - TC (OR = 2.55, P = 0.0168).

Conclusion. The established genotypes of increased T2D risk depending on gender make it possible to personalize approaches to primary T2D prevention.

Since type 2 diabetes mellitus (DM2) is characterized by a progressive loss of pancreatic beta cell function, there is a need to add insulin to current therapy in order to compensate for the disease and prevent the development of complications. The clinical recommendations suggest various options for the intensification of DM2 therapy: both monopreparations of insulin and its combination with aGPP-1. The latter have demonstrated clinical efficacy in achieving glycemic control and a favorable safety profile in clinical trials. Another important issue is the perception of treatment by the patient himself, since for many people, changing therapy or changing the “format” itself (prescribing injections) can be accompanied by additional stress.

The purpose of this study was to study the efficacy and safety, as well as the perception of patients with treatment of DM2 when using a fixed combination of insulin glargine/lixisenatide (Iglarlixi) compared with mixed insulin – biphasic aspartame 30.

Today, despite the introduction of primary and secondary prevention methods, chronic non-communicable diseases remain the main cause of high morbidity and mortality throughout the world. According to some studies, hepatic component metabolic syndrome and one of the main factors contributing to the development of cardiometabolic diseases is non-alcoholic severe liver disease. According to the results of studies, NAFLD is currently the leading cause of chronic liver diseases worldwide and is closely associated with the development of cardiometabolic pathology, in particular type 2 diabetes and CVD. This review is devoted to the epidemiology, pathophysiology of the close relationship between NAFLD and type 2 diabetes, as well as therapy affecting insulin resistance, a key link connecting these two nosologies.

Gastroenterological manifestations of endocrine diseases are an additional factor that reduces the quality of life of patients. In some cases, gastroenterological symptoms are the reason for the patient’s coming to the doctor and the detection of endocrine disease. The pathogenetic aspects of the development of disorders of the gastrointestinal tract are diverse, and therefore, unfortunately, it is not always possible to eliminate gastroenterological symptoms by only compensating the underlying disease. The combination of pathology of the gastrointestinal tract and the endocrine system can mutually aggravate the course of each other. There are also cases when gastroenterological pathology can be the root cause of some metabolic diseases, in particular, malabsorption. Currently, the possibilities of correction of gastroenterological pathology are widely studied in order to achieve compensation for the patient’s endocrine pathology, as well as to improve the quality of life of patients. The main directions are measures aimed at restoring the passage of food contents, maintaining the integrity of the intestinal wall, eliminating the inflammatory factor, as well as restoring the gu microbiota (GM) and modulating its metabolism. The latter method of correcting violations seems to be the most promising today due to the constantly growing number of scientific publications, as well as a wide range of safe and effective ways to influence GM. In addition to dietary recommendations, the issue of prescribing dietary fiber (DF) to patients as a food substrate for GM and a mechanism for controlling the number and ratio of microorganisms is becoming increasingly relevant.

Objective: development of an applied clinical calculator for calculating the appendicular mass of skeletal muscles (ASMM Calculator) in elderly patients based on bioimpedance analysis of body composition and anthropometry.

Material and methods: the algorithm of the ASMM Calculator was developed based on the analysis of the results of a single-stage crosssectional study of G. Sergi (Department of Geriatrics, University of Padua, Italy); the calculation of appendicular musculoskeletal mass and its index is based on the values of anthropometry and bioimpedance analysis of body composition.

Results:the matrix of the ASMM Calculator allows you to determine objective quantitative criteria for sarcopenia (appendicular musculoskeletal mass and its index) based on the values of five independent variables: the patient’s gender; height and body weight, electrical and reactive esistance of the body, the program provides for use directly in outpatient admission, has a volume of 12 kB, does not require specific hardware and software means, can be installed on a mobile device.

Conclusions: the use of the ASMM calculator in clinical practice allows the doctor to establish diagnostic criteria for sarcopenia in a timely manner, does not require significant professional time, provides grounds for verifying the diagnosis in accordance with the principles of evidence-based medicine; the program can be integrated into various medical information systems as a module of the medical decision support system.

NAFLD is a systemic metabolic disease that manifests itself in a variety of concomitant pathologies united by common pathophysiological mechanisms of development. NAFLD is the most common cause of chronic liver disease in the world, the prevalence of which in the general population is approximately 30% and occurs in all age categories and has no gender differences. Given the close relationship of NAFLD with metabolic syndrome, type 2 diabetes and obesity, as well as the huge contribution to the development of cardiorenal complications according to numerous studies, innovative hypoglycemic therapy in the treatment of patients with NAFLD and NASH is of particular interest. One of the most promising antidiabetic drugs, which, in addition to the hypoglycemic effect, have a dozen extraglycemic pleiotropic effects on cardiovascular, renal and hepatic function, are iNGLT type 2.

From numerous studies, it is known about the role of SGLT-2 inhibitors in reducing glycemia, cardio- and nephroprotection in patients with type 2 diabetes (DM2). SGLT-1 has been studied less, the management and activity of which may also be the key to compensation of type 2 diabetes, chronic diseases of the heart, kidneys and other organs and tissues. At the moment, inhibition of SGLT-1 in humans can only be achieved by using combined inhibitors of SGLT-1/SGLT-2. Drugs with selective inhibition of SGLT-1 are actively studied in animals and in vitro studies. This review is devoted to the principles of the action of SGLT-1, the effect of inhibition of SGLT-1 on pathological conditions, and also evaluation of the prospects for the use of SGLT-1i in humans.

Reactive hypoglycemia is a relatively rare hypoglycemic condition that develops due to the intake of large amounts of easily digestible carbohydrates. RG can be the result of an excessive insulin response associated with either insulin resistance or increased levels of glucagon-like peptide-1 and defects in glucagon regulation, and the most common cause of postprandial hypoglycemia (50-70%) is high insulin sensitivity. Such situations can occur in people who are very thin or who have significantly lost weight. The development of WG may be influenced by the patient’s dietary habits (high carbohydrate, low fat diet, alcohol consumption). In these conditions, insulin secretion becomes inadequate to blood glucose levels, causing hyperinsulinemic hypoglycemia.

This article presents a clinical case of a patient with idiopathic reactive hypoglycemia, which began to be observed in adolescence and was characterized by a decrease in glycemic levels in response to foods high in easily digestible carbohydrates

Currently, obesity is the main risk factor for the development of type 2 diabetes mellitus (type 2 diabetes) as a key link in the emergence of insulin resistance. Traditionally, the basic strategy for controlling type 2 diabetes is to normalize blood glucose levels by correcting lifestyle and lifelong use of oral and/or injectable hypoglycemic therapy. However, in recent years, doctors and researchers are increasingly turning to the possibility of remission of type 2 diabetes. Remission of diabetes mellitus is the preservation of normal values of glycemia with the complete abolition of hypoglycemic therapy (tablet or injection). Many studies reflect that lifestyle changes, such as weight loss, dieting and increased physical activity, contribute to the onset of remission of type 2 diabetes in a significant number of people. In this clinical case, we demonstrate the possibility of achieving remission of diabetes mellitus with a multifactorial approach to the treatment of type 2 diabetes mellitus, which causes stabilization of blood glucose levels, prevention of complications and improvement of quality of life, and thus, we exhibit new prospects in the treatment of this disease.