The aim. To assess the risk of fibrotic liver changes in patients with type 2 diabetes mellitus and NAFLD using a noninvasive marker, the FIB-4 index.

Material and methods. 161 patients with type 2 diabetes with signs of NAFLD were included. The FIB-4 index was calculated for all patients. A comparative assessment of clinical and laboratory data was carried out in the following groups: group 1 - patients with FIB-4<1.3 – 34.8% (n=56), group 2 – patients with FIB-4>1.3 – 65.2% (n=105). Statistical data processing was carried out using Microsoft Excel 2016 and Jamovi software packages (Version 1.0.1).

Results. Median age of patients in the general group was 59 [49.0; 67.0] years; BMI 31.6 [27.6; 35.7] kg/m2; HbA1c 9.0 [7.70; 10.9] %. The FIB-4 index >1.3 was detected in 65.2% (n=105) of patients; the FIB-4 level ≥2.67 (corresponding to fibrosis) – in 16.8% (n=27). When compared in groups 1 and 2: 51±15.0 years vs. 61 ±10.8 (p<0.001); ALT level – 42.3±28.7 U/L vs. 50.2±64.5 (p<0.001); AST level – 24.1 ±19.4 vs. 42.5±67.3 (p<0.001) U/L. Age ≥60 years increased the probability of a FIB-4 value > 1.3 by 4 times (OR 4,099, 95% CI: 1.9–8.84)), an increase in transaminase levels increased the risk of a FIB-4 value>1.3 by more than 2 times (OR 2.3, 95% CI: 1.02–5.32).

Conclusions. Patients with type 2 diabetes, according to the values of the noninvasive calculation method, have a high risk of developing fibrous changes in the liver, and therefore need more active screening of hepatic dysfunction and timely correction of the main risk factors for its development.

The aim. This study aims to investigate the clinical and pathogenetic features of pancreatic involvement in patients diagnosed with COVID-19. Material and methods. We conducted an analysis of two hundred medical records belonging to patients hospitalized with COVID-19 at the gastroenterology department of the Central Clinical Hospital of Russian Federation Presidential Administration, from March 2020 to July 2021.

Results. Among the comorbidities observed, type 2 diabetes mellitus and glucose intolerance (T2DM/GI) were present in 39 (19.5%) patients, while chronic pancreatitis was evident in 10 (5%) patients. Notably, a history of T2DM/GI correlated with prolonged hospital stays (p=0.0024). Elevated pancreatic enzyme levels were detected in 11.5% of patients, showing a significant association with the COVID-19 severity (p=0.0001) and prolonged hospitalization (p=0.0002). Furthermore, a statistically significant correlation was found between age and the risk of elevated pancreatic enzyme levels (p=0.0011).

Conclusion. The involvement of the pancreas in COVID-19 patients poses a significant clinical challenge, exacerbating overall clinical outcomes. These findings underscore the critical importance of monitoring pancreatic enzymes and glycemic profiles within the evaluation protocols of COVID-19 patients to facilitate early diagnosis and ensure prompt treatment of complications.

The modern management strategy for patients with type 2 diabetes mellitus is based on the general management of risk factors, taking into account a personalized approach to each patient. Early combined hypoglycemic therapy is a priority in achieving long-term glycemic control. The leading place in all current recommendations for the management of type 2 diabetes mellitus is occupied by drugs of the DPP- 4 inhibitor class. The combination of DPP-4 inhibitors with metformin can help preserve insulin-producing function and improve glycemic control, and, accordingly, slow the progression of type 2 diabetes mellitus and its complications. The drug gozogliptin (Saterex®) is the first original gliptin, the full production cycle of which in Russia. Gozogliptin can be recommended for patients with the onset of type 2 diabetes mellitus both in combination with metformin and in monotherapy.

Primary hypothyroidism is one of the most common endocrine diseases. The replacement therapy with levothyroxine is indicated to all patients with overt hypothyroidism. Modern tablet preparations of levothyroxine provide easy administration, simplicity of selection of the drug dose. At the same time, a fairly large number of patients who have been receiving levothyroxine preparations for a long time are in a state of decompensation. The reasons for decompensation may be low patient adherence, receiving of drugs or gastrointestinal pathology, which can affect the bio-availability of levothyroxine. This review is devoted to the discussion of the problem of decompensation of hypothyroidism and the influence of patient’s adherence on the efficacy of replacement therapy.

In recent decades, significant advances in sugar therapy have been associated with the introduction of human insulin analogues. Superfast human insulin analogues have become an important tool for achieving optimal glycemic control and improving the quality of life of patients. Due to its unique pharmacokinetics, this group of insulin preparations provides a faster and more predictable onset of action, which allows its profile to be as close as possible to the secretion of endogenous insulin. A number of clinical trials have confirmed the advantage of superfast insulin analogues in the control of postprandial hyperglycemia compared with insulin preparations of the previous generation.

Non–alcoholic fatty liver disease (NAFLD) is a general term that includes benign steatosis and non-alcoholic stethohepatitis (NASH) with the possibility of developing liver fibrosis (LF), liver cirrhosis (LC) and hepatocellular carcinoma (HCC), which are natural evolutionary stages of the disease. The widespread prevalence of NAFLD is an extremely urgent medical and social problem for public health systems in most countries of the world. The study of the prevention of NAFLD or slowing the progression of the disease is becoming a global task for the scientific community and practical healthcare. Lifestyle changes remain the main recommendation of treatment, despite various attempts to conduct clinical trials of drugs of a wide pharmacological spectrum. Among the latter, sodium-glucose co-transporter type 2 inhibitors (iNGLT-2) are becoming a promising direction. Processes regulated by the sodium-glucose co-transporter (NGL-2), such as stress on the endoplasmic reticulum (ER) and oxidative stress, sluggish inflammation, autophagy and apoptosis, play an important role in the pathogenesis of NAFLD. In this review, we summarize the current understanding of the pathophysiology of NAFLD and focus on the potential impact of iNGLT-2 on the development and progression of NAFLD, providing current research data in experimental models and clinical practice. Given these findings, further research will contribute to our fuller understanding of the exact mechanisms underlying the pathogenesis of NAFLD and the potential effects of iNGLT-2 in the treatment of NAFLD.

Type 2 diabetes mellitus (DM2) is one of the most common metabolic diseases of our time, affecting millions of people around the world. In recent years, the attention of researchers has been attracted by type 1 sodium-glucose cotransporter inhibitors (NGL-1), which open up new horizons in the treatment of this disease. Currently, there is data on the location of NGL-1 in many organs and tissues. Excessive activity of these transporters may contribute to an increase in blood glucose levels, which makes inhibition of this cotransporter a promising approach for glycemia management. This article will consider the effects of inhibition of iSGLT-1, their effect on the pathogenesis of DM2, and will also present the results of clinical studies confirming the effectiveness and safety of inhibition of iSGLT-1 in patients with DM2.

Metabolic-associated fatty liver disease (MAFLD) is a chronic, non-infectious condition associated with metabolic disorders, including type 2 diabetes mellitus. This review describes current understanding of the MAFLD pathogenesis and its relationship to impaired carbohydrate metabolism, particularly the role of insulin resistance, dysregulated autophagy, and other factors contributing to disease development. Furthermore, it analyzes existing therapeutic approaches to MAFLD management, including the use of ursodeoxycholic acid as an autophagy modulator, as well as various glucose-lowering medications, such as glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter 2 inhibitors, and thiazolidinediones. Additionally, the pathogenetic role of fibroblast growth factor-21 in MAFLD development and the potential clinical application of FGF-21-based therapies are described. Thus, this overview reflects current knowledge regarding the pathogenesis and treatment of MAFLD, highlighting the necessity of a comprehensive approach to managing this condition in the context of its strong association with impaired carbohydrate metabolism.

Type 2 diabetes mellitus continues to be one of the global medical and social problems. Early administration of combination therapy with hypoglycemic drugs acting on various pathophysiological mechanisms of diabetes development allows prolonging the duration of the therapeutic effect and achieving more stable control of blood glucose levels. Currently, a combination of metformin with dipeptidyl peptidase-4 (DPP-4) inhibitors is recommended as an initial therapy that meets these requirements. This combination has a synergistic effect on various links in the pathogenesis of the disease. The addition of gliptins to metformin enhances insulin secretion by beta cells of the pancreas and increases insulin sensitivity, which ultimately contributes to a longer preservation of the therapeutic effect. The only representative of the DPP-4 inhibitors class recommended as part of the initial combination therapy with metformin, taking into account the results of the VERIFY study, is vildagliptin. The use of a fixed combination of metformin and vildagliptin in one tablet increases patients' compliance with the treatment regimen, which, in turn, reduces the risk of complications and mortality.

Achieving compensation of carbohydrate metabolism indicators is a priority in the treatment of patients with diabetes mellitus. However, repeated measurements of glucose levels, especially in patients with type 1 diabetes mellitus (T1D), lead to rapid burnout and increased anxiety of the patient. Digital assistants help to increase the patient's commitment to treatment, compliance with the schedule of daily measurements of blood glucose, timely correction of therapy and optimization of various types of medical care (traditional visits, telemedicine consultations, online consultations). Based on clinical research data, it is currently known that the use of digital assistants contributes to achieving a stable clinical result of treatment, reducing the number of hospitalizations for diabetes decompensation, and reducing patient anxiety about their disease. This article presents a clinical case of managing a patient with T1D who used a glucometer with the ability to maintain an electronic self-monitoring diary, followed by telemedicine consultation with an endocrinologist based on data from structured reports generated in the glucometer application. The results obtained demonstrate the advantages of using individual digital assistants in the daily life of patients with diabetes.

Multiple endocrine neoplasia syndrome type 1 (MEN-1, Vermeer syndrome) is an autosomal dominant hereditary syndrome characterized by mutations in the MEN1 gene. The manifestation of the syndrome is associated with hyperplasia and tumor transformation of several endocrine glands: tumors of the parathyroid glands, pituitary gland, pancreas, adrenal glands. Within the framework of MEN-1, Zollinger–Ellison syndrome may develop – a clinical syndrome caused by hypergastrinemia, the source of which is gastrin-producing tumors of the pancreas and other localizations, resulting in hypersecretion of hydrochloric acid. This leads to the appearance of peptic ulcers of the duodenum and stomach, refractory to treatment and complicated by bleeding and stenosis. The article describes a clinical case of a young patient with the classic triad of components of MEN-1 syndrome, including multiple gastrinomas with frequent recurrences of gastric ulcer and duodenal ulcer.

Currently, monogenic forms of diabetes mellitus account for up to 6.5% of all cases of diabetes in children and adolescents. Among the 14 currently identified types of MODY diabetes, the most common are HNF4a-, GCK-, and HNF1a-MODY. Among the latter, GCK-MODY has the mildest course, often not requiring drug therapy, with a favorable prognosis in terms of micro- and macrovascular complications. The development of molecular genetics makes it possible to more accurately verify various types of diabetes mellitus, predict the course of the disease, determine treatment tactics, and conduct medical genetic counseling for families. The aim of the article: to present follow-up data from a family with GCK-MODY diabetes.