Ashot Musaelovich Mkrtumyan

Russian Association of Endocrinologists expert consensus document on initiation and intensification of antyhyperglycaemic therapyin type 2 diabetes mellitus

Current consensus proposes a differentiated algorithm of initiation and intensification of antihyperglycaemic therapy in treatment patients withtype 2 diabetes mellitus. Patient-centered approach is considered a priority at any stage of diabetes care, as it ensures efficiency and safety of treatment.This document formulates guidelines for setting adequate therapeutic goals depending on vascular complications, age, life expectancy and riskof hypoglycemic events. Therapeutic options are stratified with regard to initial HbA 1c level. This Algorithm considers all classes of antidiabetic medicationsregistered in Russian Federation, rational and irrational combinations of drugs as well as contraindications.

Consensus statement by a panel of experts of the Russian Association of Endocrinologists (RAE) on initiation and intensificationof hypoglycemic therapy for type 2 diabetes mellitus

С учетом масштаба развивающейся эпидемии СД существует острейшая необходимость разработки эффективного терапевтического алгоритма сахароснижающего лечения, позволяющего достичь компенсации углеводного обмена и предупредить развитие тяжелых сосудистых осложнений этого заболевания. При этом приоритетом в выборе терапевтических средств должна стать эффективность сахароснижающего действия препаратов при их безопасности для пациентов (как крат- косрочной, так и отдаленной).

Initiation and intensification of antihyperglycemic therapy in type 2 diabetes mellitus: Update of Russian Association of Endocrinologists expert consensus document (2015)

The current update of the consensus algorithm of initiation and intensification of the antihyperglicemic therapy in treatment of the patients with type 2 diabetes mellitus (2015) is based on the preliminary document issued by the Russian Association of the Endocrinologists in 2011. The update was needed due to new data on the safety of the traditional therapeutic options, availability of the new class of the antidiabetic medications, and necessity to add chapter about initiation and intensification of the insulin therapy. The patient-centered approach remains the absolute priority at any stage of diabetes care as it ensures the efficacy and safety of antihyperglycaemic treatment.

Cerebrovascular accidents in patients with type 2 diabetes mellitus

Cerebrovascular accident (CA) is a nowadays widely spread, highly incapacitating and often lethal event that poses a prominent clini- cal problem. Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) ? an ?epidemic? of the century, ? are known to be its primary risk factors. Hyperglycemia promotes CA risks by induction of protein glycosylation, elevation of blood plasma atherogenic potential, activation of coagulation system with higher risk for thrombosis and disturbance of microcirculation on tissue and organ lev- els. Influence of hyperglycemia on severity and extent of neurologic damage is still under evaluation. Development of macroangiopathy is thought to be associated with media calcification, distal polyneuropathy and renal disorders, all of which are cardiovascular risk factors. Application of so-called metabolic drugs resulted in certain disillusionment, as these agents failed to prove their efficacy during clinical trials. Incidence of pulmonary edema in patients with ischemic CA and T2DM is important as it dictates the necessity for use of loop diuretics. Incidence and severity of heart failure and its correlation with degree of glycemic disorders, incidence of pulmonary em- bolism, as well as tactics of management and prognosis in patients with ischemic CA and T2DM, remains a relevant research problem.

Glycemia control and glucose-lowering therapy in patients with type 2 diabetes mellitus and cardiovascular disease (review of multicenter randomized trials)

The use of modern pharmaceuticals and cardiovascular disease (CVD) treatment methods has increased life expectancy and improved the quality of life of both patients with normal carbohydrate metabolism and diabetes mellitus (DM). This study provides a review of the literature on glycaemic control and choice of glucose-lowering therapy in patients with type 2 DM (T2DM) and CVD. According to the latest recommendations for the prevention of CVD, the target level of glycated haemoglobin (HbA1c) should be less than 7.0% and 7.5%–8.0% in older patients to decrease the risk of hypoglycaemia. The target blood glucose level is 7.7–10 mmol/L. The results of randomized clinical trials (RCTs) revealed that the adverse effects of second-generation sulfonylureas include critical hypoglycaemia episodes and increases in CVD-associated complications and mortality. Metformin reduces the risk of CVD in comparison with second-generation sulfonylurea derivates and insulin. Thiazolidinediones are not currently used for patients with CVD, and the safety of GLP-1 analogues and SGLT-2 inhibitors is still under investigation. When metformin therapy is ineffective, DPP-4 inhibitors should be prescribed and renal function should be monitored. Metformin is contra-indicated in patients with severe chronic heart failure (CHF) and acute myocardial infarction (AMI) because of the risk of lactic acidosis with tissue hypoxia. Thus, insulin is the drug of choice for glycaemic control in CVD patients with chronic kidney disease, severe heart failure or other acute clinical conditions.

Perspectives on reducing mortality attributed to acute myocardial infarction among patients with type 2 diabetes mellitus in multicenter randomized trials

A review of the scientific literature was conducted to investigate reducing mortality from acute myocardial infarction (AMI) in patients with type 2 diabetes mellitus (T2DM). This included a review of literature comparing cardiovascular disease (CVD) treatment methods for AMI patients who have T2DM and those with normal carbohydrate metabolism. These treatments increase the life expectancy and greatly improve the quality of life of patients with acute myocardial infarction in both groups of patients. However, the risk of cardiovascular mortality in patients with T2DM compared with people with normal carbohydrate metabolism remains unchanged. The rapidly growing population of patients with T2DM will soon change our attitude towards the possibility of improving the prognosis and treatment of those with CVD.

Clinical and morphological characteristics, management and prognosis for acute coronary syndrome in patients with type 2 diabetes mellitus

This review addresses clinical picture of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM), the corre- sponding epidemiology data, morphological characteristics and prognosis. ACS in patients with T2DM features fulminant development, and its high lethality is due to chronic ischemic alterations in myocardium (the so-called ?metabolic ischemia?), as well as concomitant microangiopathy. It is more common for patients with T2DM to develop such complications of ACS as cardiogenic shock, acute left ventricular failure and arrhythmia that result in increased lethality during early hours of hospital admission when myocardial necrosis is yet to occur. Percutaneous translumenal intervention is by far the most effective method of ACS management in patients with T2DM. Whenever it is not available, a thrombolytic approach is indicated.

Conservative treatment for acute coronary syndrome in patients with type 2 diabetes mellitus

2 diabetes mellitus (T2DM). Dyspnea during physical exertion should be considered an anginal equivalent in patients with T2DM, and suffocation causing admission to ICU ? as a possible sign of myocardial infarction. Proximal and distal coronary lesions combined with diabetic microangiopathy compromising collateral circulation are a frequent finding in these patients. Therefore an infusion of nitroglycerine may yield a rapid improvement in their condition. Treatment with low-molecular-weight heparin (LMWH) should be administered for a longer period due to rheological disturbances in T2DM. Diabetic patients with a history of myocardial infarction (MI) should receive a life-long therapeutic combination of two different antiplatelet agents. Carvedilol, a non-selective beta blocker/ alpha-1 blocker, and selective beta-1 blockers (e.g. nebivolol, bisoprolol) have better safety profile than other beta blockers concerning neurological aspects of hypoglycemic events.

Metabolic and cardiovascular effects of early insulin glargin prescription: based on data from ORIGIN study

We discuss results of ORIGIN, a multicenter parallel groups study for efficiency assessment of insulin glargin against polyunsaturatedomega-3 fatty acids or placebo regarding cardiovascular and/or mortality risk reduction in patients with impaired fasting glycemia,impaired glucose tolerance or type 2 diabetes mellitus (T2DM) on its early stage and high risk for cardiovascular events. 12 537 patientstook part in this study; 6 264 were randomized in insulin glargin group, where dosage was adjusted for complete compensationof fasting glycemia (5.3 mmol/l was set as a therapeutic goal). After treatment with glargin therapeutic goal was achieved and furthermaintained for 6.2 years of follow-up. Compensation of fasting glycemia did not affect the outcome of cardiovascular diseases in patientswith early stages of dysglycemia according to primary endpoints. It was not associated with increase in general morbidity and inrisk of hypoglycemic events. Treatment with insulin glargin delayed progression from prediabetes to clinical onset for 28% (OR 0.72,CI 95% 0.58-0.91; p = 0,006), while lowering incidence of DM. Longtime treatment with insulin glargin does not increase incidenceof malignant tumors of different localization, including patients with prediabetes. Due to results of ORIGIN, insulin glargin (Lantus?)has become the most studied human insulin analogue to date.

Metabolic disturbances in patients with paranoid schizophrenia treated with atypical antipsychotic drugs

Цель. Изучение влияния терапии классическими и атипичными антипсихотическими препаратами (АА) на динамику толерантности к глюкозе и некоторых показателей липидного обмена. Материалы и методы. Обследовано 50 больных с развившимся впервые в жизни психотическим эпизодом, отвечающим критериям па- раноидной шизофрении (МКБ ? 10). В первую группу вошли больные, получающие галоперидол, вторую группу составили пациенты, по- лучающие атипичные антипсихотические препараты (АА). Использовались биохимический, антропометрический, статистический методы. Результаты. У 12% пациентов, получавших АА, выявлено нарушение толерантности к глюкозе на 8 неделе терапии, у 4% больных ? сахарный диабет (СД). Заключение. Терапия с использованием атипичных антипсихотических препаратов оказывает существенное влияние на состояние уг- леводного обмена у больных параноидной шизофренией по сравнению с галоперидолом.