Due to the high prevalence of complications from the cardiovascular system and kidneys in patients with type 2 diabetes mellitus (DM) already in the early stages of the disease, it is interesting to identify predictors that could be used for early diagnosis and prevention of cardio-renal complications in patients with type 2 diabetes.

Objective: to develop prognostic models for the development of ASCVD, CHF, and CKD in patients with type 2 diabetes, identifying predictors and determining the contribution of each factor in the development of these diseases.

Material and methods: A one-time observational study was conducted on a sample of patients hospitalized in the endocrinology department of the State Budgetary Healthcare Institution of the City Clinical Hospital named after V.P. Demikhov. Statistical analysis was carried out using Jamovi and IBM SPSS Statistics 23 (IBM. USA). Differences were considered statistically significant at p <0.05. The construction of a prognostic model of the probability of a certain outcome was carried out using the logistic regression method with reverse stepwise exclusion of collinear factors, calculation of the odds ratio (OR) and 95% confidence interval (CI).

Results: The study included 1150 patients with type 2 diabetes, whose median age was 65 [57;74] years, median BMI - 31.2 [26.3; 35.8] kg/m2. According to logistic regression analysis, the most significant factors associated with the development of ASCVD in the population of patients with type 2 diabetes were: duration of diabetes more than 10 years (OR 4.16 (95% CI: 3.01-5.76) (p>0.001) ) and hypertension (OR 3.92 (95% CI: 2.17-7.08). Age over 60 years (OR 2.12 (95% CI: 1.46-3.06) (p>0.001), male gender (OR 1.61 95% CI: 1.14-2.26) (p>0.006)). Predictors increasing the likelihood of CHF were: patient age over 60 years (OR 4.05 (95% CI: 2). .70-6.06), (p>0.001)), previous MI (OR 3.71 (95%(2.58-5.33), p<0.001), presence of AF 2.93 (OR 2.93 (95 % CI: 1.79-4.78), p<0.001), hypertension (OR 2.45 (95% CI: 1.29-4.65), p<0.006) and female gender (OR 1.58 ( 95% 1.09-2.28), p<0.014). Factors increasing the odds of CKD were: age over 60 years (OR 2.36 (95% CI: 1.61-3.47), p <0.001), the presence of CHF was associated with an increase in the odds of CKD by 1.86 times (p <0.001), previous MI by 1.55 times (p<0.008), female gender by 1.62 times (p<0.004) and diabetes duration of more than 10 years by 1.44 times (p>0.037).

Conclusion:  The universal predictors of the development of cardiorenal complications in patients with type 2 diabetes were: age over 60 years and hypertension. Predictors of the development of ASCVD, in addition to universal ones, were: duration of diabetes and male gender; the likelihood of developing CHF increased in patients with a history of myocardial infarction, the presence of AF, and in females. The presence of obesity increased the chances of developing CHF, but was not associated with ASCVD and CKD. The odds of developing HF were similar regardless of the duration of diabetes, while the duration of diabetes was closely associated with the development of ASCVD and renal dysfunction. The following factors were associated with the development of CKD: duration of diabetes, female gender, history of CVD and female gender.

The coronavirus infection (COVID-19) pandemic remains a hot topic of study to this day. According to studies, mortality in patients with COVID-19 and a history of diabetes mellitus (DM) is 2-3 times higher than in patients without DM.

The purpose of the study is to analyze the course of coronavirus infection in patients with T2DM.

Material and methods: A prospective observation of 381 patients with T2DM and COVID-19 in the intensive care unit was carried out in 2020-2021. 2 groups were formed: Group I (comparison group) – patients with a fatal outcome, Group II (control group) – patients discharged from the hospital with an improvement in their condition. An assessment was made of changes in the dynamics of clinical and laboratory parameters upon admission and before discharge in both groups.

Results and discussion: Patients with a fatal outcome were more often admitted in a serious condition (75% vs. 12.7% at p ≤ 0.0001). Significantly more often than aches (92.5% vs. 69.58%, p=0.0044), shortness of breath on exertion (92.5% vs. 75.17%, p=0.0245), grade 3 DN (62.5%, p<0.0001), the need for non-invasive lung ventilation (28.95% versus 1.39%, p <0.0001) artificial lung ventilation (81.1% versus 1.75% ( p<0.0001) was noted in group I. In the comparison group, the Charlson comorbidity index was higher: 6.0 [5.0;7.0] versus 4 [4; 4], at p<0.0001. In the group of patients who were discharged with improvement, they more often took metformin and sulfonylureas, in the group of patients who died, they were more often on insulin therapy. In dynamics, the levels of intracellular enzymes such as alkaline phosphatase, creatine phosphokinase, lactate dehydrogenase in the group with an unfavorable outcome significantly increased, in contrast to the group with a positive outcome. Also, in a fatal outcome, there is a deterioration in kidney function, laboratory characterized by an increase in the level of creatinine and urea, a decrease in the glomerular filtration rate and blood albumin. Despite the ongoing anticoagulant therapy, patients with a fatal outcome showed pronounced signs of activation of the hemostasis system, which are characterized by an increase in INR, prolongation of prothrombin time and aPTT, and thrombocytopenia.

Conclusion.  The risk of death from coronavirus infection in people with diabetes increases with age. DM 2 is a comorbid disease and acute multiple organ disorders develop with the addition of a coronavirus infection. Coronavirus-induced coagulopathy in patients with DM2 and COVID-19 with a fatal outcome is characterized by poor controllability and low efficacy of anticoagulant therapy.

It is known that COVID-19 patients with concomitant type 2 diabetes mellitus and severe dyslexic disorders are characterized by a more severe course of combined pathology. In this regard, the choice of hypoglycemic therapy for effective management of glycemia is important. The review examines publications shedding light on the therapeutic potential of taking gliclazide MV in patients with a combination of mild COVID-19 and diabetes mellitus.

Obesity is a global health problem associated with various comorbidities and increased mortality. Obesity is of particular importance in relation to the development and progression of type 2 diabetes mellitus (T2DM), being its main pathophysiological factor. Lifestyle changes are the most important mechanism for weight loss, but may not be sufficient for sustainable weight loss. Pharmacologic agents such as glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists) are recommended as an adjunct to lifestyle interventions to promote and maintain clinically meaningful weight loss and reduce the risk of comorbidities. Since 2005, several GLP-1 agonists have been approved for the treatment of type 2 diabetes, including exenatide (short- and long-acting), lixisenatide, liraglutide, dulaglutide, and semaglutide. Of these, semaglutide (subcutaneous) and liraglutide are currently approved by the US Food and Drug Administration (FDA) for ongoing weight control in patients with or without diabetes. Semaglutide therapy resulted in significant and sustained weight loss and improvement in cardiometabolic risk factors compared with placebo, was well tolerated, and had a safety profile consistent with other GLP-1 agonists. The most common side effects with semaglutide are gastrointestinal events, which were transient, mild to moderate in severity, and usually resolved without permanent discontinuation of treatment.

Currently, the issue of obesity and its impact on various aspects of human health is actively being discussed. The role of obesity in the development of metabolic syndrome is well known. Within the study of the obesity pandemic, the modern medical community is conducting research in the field of reproductive health. In women, markers of ovarian reserve are considered, with the main one being the level of anti-Mullerian hormone (AMH). It is known that with age, the number of AMH and antral follicles in a woman's body decreases. However, there is data in the modern literature indicating a decrease in ovarian reserve parameters in conditions of weight gain. Weight gain is accompanied by a imbalance of adipokines - biologically active substances produced mainly by adipose tissue and other tissues of the body that affect metabolic processes. It can be assumed that a deep study of the relationship between decreased reproductive potential and obesity, timely prevention of metabolic disorders will improve fertility indicators.

Arterial hypertension (AH) is one of the leading problems of cardiological communities around the world. In patients with diabetes mellitus (DM), hypertension occurs 2 times more often than in the general population, being mutually aggravating diseases and leading risk factors for coronary heart disease, stroke, congestive heart failure and chronic kidney disease, which lead to disability and increased cardiovascular mortality. Various cardiological and endocrinological communities pay special attention to the management of hypertension in patients with DM, taking into account comorbidity. The present review examines modern approaches to the management of hypertension in DM patients based on current international clinical recommendations. Most of the current practical guidelines and clinical recommendations emphasize the need for early combined antihypertensive therapy for diabetes, which is due to the complex multifactorial pathogenesis and a more severe course of hypertension in disorders of carbohydrate metabolism. The main groups of antihypertensive drugs recommended for diabetes include: angiotensin converting enzyme inhibitors/angiotensin receptor blockers, thiazide/thiazide-like diuretics, calcium antagonists.

Adrenocortical cancer (ACС) is a rare malignant endocrine neoplasm from adrenocortical cells. Despite the orphan character of the disease, the increase of incidentalomas in modern clinical practice requires endocrinologist's awareness of the principles of diagnostics and tactics of patient management. This disease is characterized by highly variable biological behavior. This peculiarity of ACC necessitates a personalized approach for each clinical case, which should be ensured not only by interdisciplinary interaction between oncologists, surgeons and endocrinologists, but also by analysis of the pathomorphological features of each tumor. The present article highlights the current views on the morphological diagnosis of ACC, obtained as a result of research in the last decade, which should be taken into account by the endocrinologist.

Metformin is recognized as the "gold standard" for the treatment of type 2 diabetes mellitus (DM2). Its hypoglycemic properties are realized by reducing insulin resistance, contributing to the utilization of glucose in liver cells, muscles and adipose tissue; suppression of gluconeogenesis in the liver. Due to the wide range of biochemical targets of its pharmacological action, the scientific community actively discusses the use of metformin as an organoprotective drug. Now, the beneficial effect of metformin on the course of neuropathy, diseases of the cardiovascular system, normalization of the composition and metabolic activity of the intestinal microbiota, the course of metabolically associated fatty liver disease has already been proven, the nephroprotective effect has also been proven, and the study of the anti-oncogenic properties of metformin continues. The number of publications devoted to research on the positive effects of metformin on various organs and systems is actively increasing, and data on the identification of new effects are regularly published. The purpose of this literature review is to analyze the pleiotropic effects of metformin at the level of biochemical interactions for a more detailed understanding of the principles of their implementation.

The main clinical manifestation of osteoporosis is a low-energy fracture.  Fracture is associated with a high risk of disability and  mortality. Therefore, the aim of osteoporosis treatment is to reduce  the risk of fractures. Therefore, experts from the UK in  2019 developed and put into practice a fracture risk stratification  system, on the basis of which a decision is made  on the treatment of patients with osteoporosis. So patients with  a very high risk of fractures need to prescribe anabolic  therapy, followed by the appointment of antiresorptive drugs. Patients at  high risk –    the appointment of antiresorptive therapy, and if  it is ineffective, the appointment of anabolic therapy. Patients with low and intermediate risk are recommended dynamic monitoring with constant reassessment of the risk of fractures. This conclusion completely changes  the existing paradigm of osteoporosis treatment.

The syndrome of apparent  mineralocorticoid excess (AME) is a rare genetic disease characterized by  juvenile hypertension, hypokalemia, suppression of renin and aldosterone. AME syndrome is caused by a mutation in the HSD11B2 gene, which encodes 11ß-hydroxysteroid dehydrogenase type 2, that converts cortisol into cortisone.

The  purpose of the article is to describe a clinical case  of genetically confirmed (mutation C.911A>G of the HSD11B2 gene) AME  syndrome. The disease manifested in the first years of life; the patient was prescribed mineralocorticoid receptor antagonists, potassium preparations, potassium-sparing diuretics, and other antihypertensive therapy. Due to the absence of normotonia and normokalemia, dexamethasone has been prescribed since the age  of 12. Due to uncontrolled arterial hypertension and hypokalemia, complications  developed (medullary nephrocalcinosis, myocardial remodeling), and prolonged dexamethasone intake led  to a slowdown in puberty and a decrease in bone  mineral density.