Elena Valer'evna Biryukova

Russian federal clinical guidelines on the diagnostics, treatment, and prevention of osteoporosis

Screening using the Fracture Risk Assessment Tool (FRAX) is recommended in all postmenopausal woman and mеn over 50 (A1) in order to identify individuals with high probability of fractures. It is recommended to diagnose osteoporosis and start treatment in patients with fragility fracture of large bones of the skeleton and/or high individual probability of major fragility fractures (FRAX) and/or detected decrease in bone mineral density (BMD) up to –2.5 T-score as assessed by DXA in the femoral neck and/or lumbar vertebrae (A1). Patients with back pain, lifetime height loss of 4 cm or height loss of 2 cm since a previous medical examination, those who receive glucocorticoids, patients with long lasting decompensated type 2 diabetes mellitus, or those receiving insulin therapy, as well as patients who were previously diagnosed with fragility fractures at the other sites are advised to underwent standard lateral X-ray imaging of the spine (Th4—L5) in order to verify the presence of compression vertebral fractures (B1). Dual-energy X-ray absorptiometry (DXA) is recommended for individuals whose 10-year probability of major osteoporotic fracture (FRAX) falls within the medium risk group (B1). It is recommended to include the trabecular bone score (TBS) the FRAX algorithm in order to improve the sensitivity of this method (B1). Laboratory testing is recommended for the differential diagnosis with other causes of increased skeletal fragility in all patients with newly diagnosed osteoporosis and when previously prescribed antiosteoporostic treatment was ineffective (B1). Bisphosphonates (BPs), antibodies to receptor activator of nuclear factor kappa-beta ligand (RANKL) (denosumab), or parathyroid hormone analogue (teriparatide) are equally recommended to prevent fragility fractures and increase BMD in patients with osteoporosis (A1). Denosumab is also recommended to prevent BMD loss and fractures in females receiving aromatase inhibitors therapy for breast cancer and males with prostate cancer receiving hormone-deprivation therapy and having no bone metastases (A1). Since teriparatide has the anabolic effect, it is recommended as the first line treatment in patients with severe osteoporosis having history of vertebral fractures, in the individuals with very high risk of fragility fractures, or in the cases when antiresorptive treatment was ineffective (B1). All medications for treatment of osteoporosis are recommended in combination with calcium and vitamin D supplements (A1).

Clinical implementetion of vildagliptin: data from recent studies comparing incretin-based medications

The introduction of DPP-4 inhibitors substantially increased therapeutic options for type 2 diabetes mellitus (T2DM). The unique mechanism of action allows using these agents both as monotherapy and in combination with conventional anti-diabetes drugs. Evidence base for efficacy and safety of DPP-4 inhibitors deepens every year, but to date only a few studies addressed direct comparison between individual agents within this pharmacological class. Current article presents data from the studies comparing vildagliptin with other DPP-4 inhibitors, as well as GLP-1 agonists.

Diabetes mellitus and pyoinflammatory diseases of ENT organs

Current review addresses diagnostic issues and treatment of patients with diabetes mellitus (DM) and pyoinflammatory diseases ofENT organs. We discuss etiologic and pathogenetic factors affecting course of pyoinflammatory processes in ENT organs of diabeticpatients

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.

Effective and safe control of glycemia with insulin Apidra - the recipe for success of type 2 diabetes prophylaxis

Current possibilities for the use of ultra-short acting insulin analogs are discussed. The importance of control of postprandial hyperglycemia is emphasized.Pharmacological properties of insulin glulisine are described with special reference to its advantage over human ultra-short acting insulin.An important characteristic of glulisine is the possibility of its efficacious use for the treatment of obese patients. The results of GINGER and CHOinternational studies suggest high efficacy and safety of glulisine used for intensive insulin therapy according to both flexible and fixed regimens.

Efficacious and safe control of glycemia using Apidra insulin

Diabetes mellitus (DM) is a stably growing pathology leading to micro- and macrovascular complications. Despite high potential of medicamentaltherapy for DM its efficacy needs to be further improved. Uncompensated postprandial hyperglycemia is known to be responsible for many diabeticcomplications. Moreover, it by itself aggravates disturbances of insulin secretion through the toxic effect of glucose. Insulin therapy remains a principaltool for the treatment of DM. Its efficiency was greatly improved with the advent of fast-acting insulin analogs obtained by reducing stability of hexamers.Insulin glulysine (Apidra) is the fastest-acting analog licensed for the treatment of DM1 and DM2 in adult patients in 2004 (FDA, EMEA) andin children above 6 years in 2008 (EMEA). A characteristic feature of this analog is the absence of Zn2+ in its molecule that substitutes polysorbate-20 acting as a surfactant and providing additional protection of monomers from denaturation.

New strategies of insulin therapy - a way to effective glycemic control of type 2 diabetes mellitus

This paper focuses on the approaches to target glycemic control in patients with type 2 diabetes mellitus. It is emphasized that timely onset of insulintherapy enhances glycemic control and reduces the risk of vascular complications. One way to achieve this goal is to use modern strategies of intensivehypoglycemic therapy with insulins having improved pharmacokinetic and pharmakodynamic properties, e.g. glargine (Lantus) and glulysine (Apidra).Results of international clinical studies confirm effi-ciency of basal and basal-plus insulin strategies allowing to achieve glycemic control in type 2diabetes without heightening the risk of hypoglycemia, development and progression of vascular complications.

Mozhno li dostignut' effektivnogo glikemicheskogo kontrolya sakharnogo diabeta 2 tipa: preimushchestva rannego naznacheniya insulina

Приоритеты при выборе фармакотерапии СД 2 в настоящее время достаточно обоснованно и точно определены в достигнутом консенсусе ADA и EASD. Прогрессирующее ухудшение метаболического статуса и толерантность к улучшению функции ?-клеток обосновывает более агрессивную тактику лечения СД 2, оправданную уже на начальных стадиях заболевания. Ранняя инсулинотерапия в индивидуально подобранных дозах с использованием современных аналогов человеческого инсулина (Лантус) в виде комбинации с ПСП или монотерапия инсулином ? это лучший путь достижения основных целей лечения, открывающий широкие перспективы: поддержание долгосрочного метаболического контроля и предотвращения или отсрочки сосудистых осложнений.

Molekulyarno-geneticheskie osobennosti, kharakter metabolizma glyukozy i funktsiya endoteliya u bol'nykh metabolicheskim sindromom russkoy populyatsii

При синдроме ИР сосудистая дисфункция развивается задолго до явных нарушений углеводного обмена, что свидетельствует о важности раннего выявления ИР как фактора риска эндотелиальной дисфункции. Под влиянием комплекса характерных для синдрома ИР гормонально- метаболических и гемодинамических нарушений функция эндотелия претерпевает сложные изменения, что в итоге приводит к преобладанию вазоконстрикции, раннему развитию атеросклеротических изменений и создает предпосылки для возникновения и быстрого прогрессирования сердечно-сосудистых заболеваний.

Effektivnaya i gibkaya farmakoterapiya ozhireniya segodnya - zalog uspeshnoy profilaktiki sakharnogo diabeta 2 tipa v budushchem

Ожирение является не только важнейшей медицинской, но и социально-экономической проблемой современного общества. Так, экономические затраты в связи с лечением ожирения и его осложнений очень велики: в развитых странах мира расходы на лечение ожирения и сопутствующих ему заболеваний составляют 8?10% от всех затрат на здравоохранение. Снижение массы тела позволяет существенно уменьшить клинические проявления, улучшить контроль и повысить эффективность терапии коморбидных заболеваний. Лечение ожирения ? достаточно сложная задача, поскольку это хроническое заболевание, требующее длительного, систематического наблюдения и лечения.