The aim. To determine the role of obesity in the development of diabetic distress in patients with type 2 diabetes, to identify clinical and laboratory features of patients with type 2 diabetes and diabetic distress.

Material and methods. 152 patients (72 men and 80 women) with type 2 diabetes participated in the study, 76 of them were non-obese (group 1), 76 had a BMI >30 kg/m2 (group 2). The average age of patients is 51 [40; 60] years. The experience of diabetes mellitus in the studied patients is <10 years. All patients underwent the determination of HbA1c, waist circumference, diagnosis of diabetic distress using a specialized PAID questionnaire and assessment of depression using the Beck scale. Statistical data processing was carried out using the software packages Microsoft Excel 2016 and STATISTICA.

Results. Patients with type 2 diabetes and obesity have significantly more pronounced diabetic distress on the PAID scale, a higher level of depression on the Beck scale, as well as a significantly higher index of HbA1c. In the group of patients with a high probability of diabetic distress, the average level of HbA1c was significantly higher by 0.88%, and the waist circumference was 8.3 cm larger. As a result of the correlation analysis, a direct correlation was revealed between waist circumference and the number of points according to the PAID questionnaire.

Conclusion. Obesity in type 2 diabetes is a risk factor for diabetic distress and is associated with a higher risk of depression. Diabetic distress is associated with higher values of HbA1c and the severity of abdominal obesity, which worsens the control of diabetes mellitus, which means that it may indirectly increase the risk of complications. Understanding diabetic distress and effective management strategies can significantly improve the effectiveness of treatment and improve the quality of life of patients with type 2 diabetes and obesity.

The aim. Analysis of the relationships between local bioimpedance measurements and quantitative estimates of visceral fat deposition obtained by various indirect methods.

Material and methods. The program included measurement of anthropometric features and determination of body composition in traditional (octopolar for 770InBody and tetrapolar for ABC-02 Medas) and local schemes in the abdominal area (ABC-02 Medas). The 770InBody analyzer was used to determine the visceral fat area (VFA), and the ABC-02 Medas – for local impedances in the subcutaneous (Z_sc) and visceral (Z_visc) leads.

Results. A cross-sectional continuous study was conducted at the National Medical Research Center of Endocrinology of the Ministry of Health of the Russian Federation. A total of 48 people (38 women and 10 men) aged 24 to 74 years were examined using a single program. A comparative analysis of a set of features in the subgroups of men and women was carried out. Sexual dimorphism was not detected for the features characterizing visceral fat deposition (BF₁₀ <3.0). A positive dependence close to linear was observed between the features; the nature of the relationship in the subgroups of men and women did not differ. Correlation analysis revealed a strong relationship between local impedances and VFA (0.751 [0.594; 0.853] and 0.819 [0.697; 0.895]). Analysis in subgroups with different nutritional status revealed significant differences (p <0.001) for all the studied features. Subgroups with grade 1 and 2 obesity do not differ in all studied characteristics, whereas subgroups with underweight, normal body weight, and morbid obesity demonstrate significant differences.

Conclusion. The results of the conducted study allow us to conclude that local BIA leads in the abdominal region, obtained on a domestic analyzer, have a strong correlation with other signs characterizing visceral fat deposition (VFA, SAD, WC).

The kidneys are a key organ that supports glucose homeostasis in the body. The most important and clinically interesting glucose transporters at the renal level are type 1 sodium-glucose cotransporters (SGLT1) and type 2 (SGLT2). Their adequate work in conditions of euglycemia ensures complete reabsorption of glucose by the kidneys. However, with type 2 diabetes mellitus (T2DM2), it is necessary to inhibit the action of these transporters. Thus, SGLT2 inhibitors (iSGLT2) provide a decrease in blood glucose levels due to glucosuria. Simultaneously with glucosuria, natriuresis occurs, which provides a decrease in the activity of the systemic and renal renin-angiotensin-aldosterone system, a decrease in the severity of the sympathetic nervous system, a decrease in blood pressure, a decrease in the severity of interstitial edema, which together determines the cardioprotective and nephroprotective effects of iSGLT2. Therefore, iSGLT2 should be prescribed to all patients with T2DM2 and the presence of chronic kidney disease (CKD) and/or cardiovascular diseases (CVD). Moreover, data from clinical studies, as well as modern clinical recommendations, dictate the need to prescribe drugs from this group for CKD without T2DM2 and for heart failure without T2DM2.

Metformin, long considered a mainstay of treatment for type 2 diabetes mellitus (T2DM), has recently received new evidence of its effectiveness. Results from a 24-year follow-up of patients who completed the 20-year UKPDS study have demonstrated a significant benefit of early metformin administration in preventing diabetes complications. The extension study included 1489 patients with a mean age of 70.9 years. After 42 years of follow-up after randomization in the UKPDS, the metformin group retained a numerical advantage in preventing T2DM outcomes compared with the sulfonylurea/insulin group: any outcome related to DM (18% vs. 10%), death related to DM (25% vs. 16%), death from any cause (20% vs. 10%), myocardial infarction (31% vs. 17%). These results were significantly different from the diet therapy group (p <0.05). Thus, metformin was found to have a primary preventive effect on the outcomes of T2DM, which persists throughout almost the entire life of the patient with this disease.

Adrenocortical cancer (ACС) is a rare malignant endocrine tumor from cells of the adrenal cortex with an incidence of 0.7–2 cases per 1 million population per year. Due to difficulties in diagnosis, ACС is detected already at the stage of metastasis, which limits the possibilities of surgical intervention and implies an unfavorable prognosis. The composition of the tumor microenvironment is crucial for the development of strategies for immunotherapeutic treatment of cancer. One component of the tumor microenvironment is immune cells, the presence of which is often associated with a better prognosis for patients. The purpose of this review is to describe the current possibilities for predicting the course and treatment of patients with ACC, as well as to focus on the latest published data on the immune microenvironment of the tumor in order to give some ideas about the prospects for its use for personalized patient management.

Obesity is a chronic progressive disease that poses a major problem for modern healthcare due to the high and rapidly growing prevalence and development of severe complications such as cardiovascular diseases, type 2 diabetes mellitus, malignant neoplasms, etc. Effective treatment of obesity requires an integrated approach, where drug therapy and, in some cases, bariatric intervention complement lifestyle measures – nutrition correction and the use of regular physical activity. Successful treatment of obesity requires an individual approach to the patient, taking into account the initial body weight, the presence of risk factors or developed concomitant diseases, as well as the dynamics of weight loss during therapy. Drug therapy is an important part of the treatment of obese patients, because it allows you to achieve a more significant result of weight loss, and, importantly, to maintain a reduced weight. Drugs of the GLP-1 agonists, widely used today in the treatment of obesity, not only directly affect body weight, but also reduce the risks of severe cardiovascular diseases and metabolic disorders, thus leading to an improvement in the quality of life and an increase in its duration. The article presents the main approaches to the treatment of obese patients with a description of the modern possibilities of pharmacological treatment of obesity.

The review provides data on complications of the lower extremities in patients with diabetes mellitus: diabetic peripheral neuropathy, impaired arterial blood flow in the lower limbs, diabetic foot syndrome. The issues of their pathogenesis, diagnosis, and differential diagnosis are outlined. The principles of therapy and prevention of diabetes mellitus complications are considered.

Diabetic retinopathy (DR) and diabetic macular edema (DME) are common chronic complications of diabetes mellitus, the fight against which is an urgent problem of modern healthcare. DR is the fifth most common cause of blindness worldwide and the main cause of vision loss in patients with diabetes. An interdisciplinary approach plays a key role in the effective management of DR, in which the role of the endocrinologist is to achieve optimal indicators of glycemic control as the main pathogenetic factor, and regular referral to screening of patients from risk groups. In turn, ophthalmologists are faced with the task of directly diagnosing changes in the fundus and treating eye diseases at various stages. Modern ideas about the mechanisms of development of DR and the role of VEGF allow us to identify several main areas of therapy. Thus, the main method of treating DR is laser retinal coagulation (LRC), and the most effective method of treating DME is considered to be a combination of LRC and intravitreal administration of angiogenesis inhibitors. Currently, intravitreal administration of agents that prevent the neoangiogenesis is the first-line treatment for DME involving the center of the macula. This review provides information on the pathogenesis, modern classification and current approaches to the management of patients with DR in the framework of the interaction of an ophthalmologist and an endocrinologist.

The prevalence of type 2 diabetes mellitus (T2DM) is steadily increasing. Currently, highly effective modern classes of glucose-lowering medications (GLM) have largely put non-drug interventions on the back burner. At the same time, the maximum realization of the potential of GLM is possible only if the patient's lifestyle is changed. If we look at the publication activity in this area, a significantly more number of scientific articles are devoted to the nutrition therapy, and physical activity (PA) has received much less attention. This publication discusses issues such as the classification of physical exercises, benefits of regular PA, principles of designing physical therapy classes, recommendations for PA to the patients with T2DM, as well as barriers to expansion of PA and possible ways to overcome them.

Glucagon-like peptide-1 receptor agonists (GLP-1) represent an innovative class of hypoglycemic drugs, the clinical effects of which have gone far beyond glycemic control. The wide prevalence of GLP-1 receptors in organs and tissues of the human body provides many clinically significant pleiotropic effects of GLP-1. The results of a series of large randomized clinical trials demonstrated the high efficacy, good tolerability and safety of GLP-1 agonists in the management of cardiometabolic health, which determined their preferential position in clinical guidelines. A special place in the line of drugs of the GLP-1 receptor agonist class is occupied by liraglutide and semaglutide, due to their special additional effects on weight loss and effect on major cardiovascular outcomes, which allowed to expand the indications for their use in the treatment of obesity and reduction of CVD and overall mortality. The article presents a literature review of current data on the mechanisms of action and metabolic effects of GLP-1 receptor agonists.

Currently, stroke ranks second among the causes of death worldwide. Not only diabetes mellitus, but also prediabetes increase the risk of ischemic stroke, including recurrent stroke. Thus, in the management of patients with diabetes mellitus and prediabetes, an important aspect is the implementation of measures for the primary and secondary prevention of ischemic stroke. Both primary and secondary prevention of stroke in patients with metabolic disorders include lifestyle modification, control and maintenance of blood pressure and low-density lipoprotein cholesterol, and blood glucose control. In patients with diabetes mellitus and prediabetes, pioglitazone, a hypoglycemic drug of the thiazolidinedione group, in addition to a statistically significant decrease in blood glucose levels, reduces the risk of primary and recurrent ischemic stroke.

Type 2 diabetes mellitus (T2DM) is characterized by annually progressive morbidity, the development of late disabling micro- and macrovascular complications, and an increased incidence of chronic heart failure. At the same time, the development of medicine has naturally led to an increase in the average life expectancy of the population in developed countries and an increase in the number of elderly and senile people. All this puts a tremendous burden on the healthcare system and complicates the task of improving the quality of life of patients with T2DM. As is known, T2DM in the elderly significantly increases the risk of disabling complications and mortality. Dipeptidyl peptidase type 4 inhibitors (iDPP-4) have occupied one of the key places in the strategy of T2DM therapy in elderly patients, and in the Algorithms of specialized medical care for patients with diabetes mellitus they are noted as preferred for residential patients. However, according to the Federal Register of Patients with Diabetes Mellitus, the proportion of patients taking iDPP-4 decreases with increasing duration of the disease. In elderly patients, a number of reasons contribute to this. Probably, this is the lack of preferential gliptin coverage in a number of regions of Russia, experts' concerns about the insufficient hypoglycemic effectiveness of iDPP-4 with a decrease in beta cell function with an increase in the length of service of T2DM, and often unjustified transfer of patients to basic insulin therapy, which dictates the need to cancel iDPP-4. This review will present the features of the course and tactics of treatment of T2DM in the elderly and consider in detail the efficacy, safety and potential pleiotropic effects of iDPP-4 in this category of patients. Special attention will be paid to the first iDPP-4 registered in the world, sitagliptin.

Macroprolactinemia is considered to be a common cause of hyperprolactinemia. The clinical presentation of patients with macroprolactinemia often has lack of hyperprolactinemic symptoms, and performing a macroprolactin assay can prevent the prescription of unnecessary investigation and treatment. However, there is no definite understanding of whether macroprolactin actually has reduced biological activity compared to the monomeric form of prolactin. Also, due to the autoimmunity of macroprolactin, the question of the possible association of this phenomenon with other autoimmune diseases is relevant. The aim of this review is to analyze the electronic database PubMed, eLIBRARY for articles that included any of the related key words to analyze all the relevant literature on the topic of macroprolactinemia. Two clinical cases of macroprolactinemia in patients with hyperprolactinemia are presented as well.