Gagik Radikovich Galstyan

Rates and predictors of hypoglycaemia in 27 585 people from 24 countries with insulin-treated type 1 and type 2 diabetes: the global HAT study.

To determine the global extent of hypoglycaemia experienced by patients with diabetes using insulin, as there is a lack of data on the prevalence of hypoglycaemia in developed and developing countries.

Association of blindness to intensification of glycemic control in insulin-dependent diabetes mellitus

Intensive glycemic control (IGC) in previously hyperglycemic insulin-dependent diabetes mellitus (IDDM) patients is associated with a decreased long-term risk of progression of diabetic retinopathy (DR); up to 12 months after institution of IGC, however, the risk of progression of DR transiently increases. In an observational study, a cohort of 122 patients with IDDM was followed prospectively for changes in glycosylated hemoglobin (HbA1, normal < 8%) and in DR 0-12 months after institution of IGC. In six of these patients (women, mean age 24 years, duration of diabetes 14.3 years, with incipient nephropathy and retinopathy) a total of seven eyes went blind after 6-12 months of IGC, despite laser coagulation treatment. From the whole sample, a control groups of eight patients (six women) was set up, matched for age, duration of IDDM, degree of retinopathy, visual acuity, blood pressure, and microalbuminuria, with preserved vision after 12 months of IGC. In the case patients, the mean (95% confidence interval) initial HbA1 was 14.9% (13.8%-16.1%), versus 13.4% (12.4%-14.4%) in the control patients (p < 0.05). The mean HbA1 decrements after 4 months of IGC, were 3.0% (1.9%-4.1%) in the cases, and 2.1% (1.2%-3.0%) in the controls (NS); and after 12 months, the respective decrements were 4.9% (2.4%-7.4%) in the cases versus 2.0% (0.5%-3.5%) in the controls (p = 0.04). In conclusion, IGC with a decrement of > 2% per year is associated with a high risk of progression of antecedent diabetic retinopathy to blindness in IDDM patients with an extremely high initial HbA1.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of type 2 diabetes mellitus (T2DM) in the adult Russian population (NATION study).

AIM To estimate type 2 diabetes mellitus (T2DM) prevalence in Russian adults. METHODS NATION is a national, epidemiological, cross-sectional study, conducted in Russia. In adults (aged 20-79 years), recruitment was stratified by age, sex, geographic region and settlement type to obtain a representative sample. Recruitment was in public areas with high numbers of people. T2DM was diagnosed by glycated haemoglobin A1c (HbA1c) levels (diabetes: HbA1c ≥6.5% [≥48mmol/mol]; pre-diabetes: HbA1c ≥5.7 to <6.5% [≥39 to <48mmol/mol]). Socio-demographic and anthropometric data were collected. RESULTS Blood samples from 26,620 subjects were available. Overall, 5.4% were diagnosed with T2DM (previously diagnosed: 2.5%; previously undiagnosed: 2.9%); 19.3% were pre-diabetic. T2DM prevalence increased with age (up to 70 years) and was higher among females than males (6.1% vs. 4.7%, p<0.001). The estimated proportion of subjects with pre-diabetes and T2DM tended to increase with increasing body mass index. T2DM prevalence was higher in rural versus urban populations (6.7% vs. 5.0%, p<0.001). CONCLUSION In the Russian adult population, 19.3% had pre-diabetes, T2DM prevalence was 5.4%, and 54% of subjects with diabetes were previously undiagnosed. These results may help to develop a new T2DM predictive, preventative and management programme in Russia.

The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study)

Aim . To estimate the prevalence of type 2 diabetes mellitus (T2DM) in Russian adults. Materials and methods . NATION was a national, epidemiological, observational, cross-sectional study. The sample of adults (20–79 years old) was stratified by age, sex, geographic region and settlement type to obtain a representative sample. Recruitment was performed in public areas with large number of people. T2DM was diagnosed by glycated haemoglobin A1c (HbA1c) levels (diabetes: HbA1c≥6.5%; pre-diabetes: HbA1c≥5.7% to <6.5%). Socio-demographic and anthropometric data were collected. Results . Blood samples from 26,620 subjects were available. Overall, 5.4% were diagnosed with T2DM (2.5% were previously diagnosed and 2.9% were previously undiagnosed); 19.3% were pre-diabetic. T2DM prevalence increased with age (up to 70 years), and no significant difference was revealed between females and males (5.6% vs. 5.1%). The estimated prevalence of pre-diabetes and T2DM tended to increase with increasing BMI. T2DM prevalence varied by geographic region and was higher in rural areas than in urban areas (6.7% vs. 5.0%, p < 0.001). Conclusion . Approximately one in five adult Russians had pre-diabetes, 5.4% had T2DM and about half of the diabetic subjects were previously undiagnosed. These results demonstrate the need for new programs in the Russian Federation to predict, prevent and manage T2DM.

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).

Correction of Retrograde Ejaculation in Patients with Diabetes Mellitus Using Endourethral Collagen Injection: Preliminary Results.

INTRODUCTION Diabetic neuropathy secondary to diabetes mellitus type 1 (DM1) is responsible for retrograde ejaculation (RE) in 5-18% of cases. Medical treatment of RE is based either on increasing the sympathetic tone of the bladder or on decreasing the parasympathetic activity. However, the onset of side effects and the lack of response should be considered. AIMS The aim of this study was to analyze long-term outcome of endourethral injection of volume-forming material (VFM) of collagen type 2 into bladder neck submucosa in patients with RE secondary to DM1. METHODS Twenty-four patients with complete RE refractory to imipramine and DM1 were included in the study. Patients were single-blinded randomized according to a computer-generated random sequence with a 1:1 ratio in two treatment groups, namely group A (endourethral collage type 2 injection) and group B (endourethral saline water injection). New technique includes an endoscopic injection of VFM such as collagen (Correcting MIT®, Ltd. minimally invasive technologies, Moscow, Russia) into bladder neck submucosa. Primary endpoint of the study was the reduction of semen antegrade volume (mL). Secondary endpoints were considered as the changes of antegrade count (millions/mL), antegrade total motility (%), antegrade progressive motility (%), State-Trait Anxiety Inventory, Beck Depression Questionnaire and International Index of Erectile Function (IIEF-5). Pregnancy rate was calculated in each group. RESULTS Twenty-three patients completed the study. In group A, significant differences from baseline to 12 months were observed relative to antegrade volume (mL) (mean difference: 0.71, P < 0.05), antegrade count (millions/mL) (mean difference: 45.6, P < 0.05), antegrade total motility (%) (mean difference: 15.4, P < 0.05) and antegrade progressive motility (%) (mean difference: 8.4, P < 0.05). In group A, we observed significant differences in terms State-Trait Anxiety Inventory (mean difference: -20.5, P < 0.05) and Beck Depression Inventory (mean difference: -8.4, P < 0.05) with significant differences compared with group B. We observed significant improvements in group A vs. group B when considering primary and secondary endpoints of the study, but not for the IIEF-5. CONCLUSION Correction of RE in DM1 patients could be achieved with endourethral injection of collagen type 2.

Optimizatsiya i intensifikatsiya insulinoterapii pri sakharnom diabete 2 tipa (klinicheskie rekomendatsii)

По данным Государственного регистра больных сахарным диабетом, на 1 января 2009 года в России сахарный диабет (СД) выявлен более чем у 3 миллионов человек, из них 2,7 миллиона приходится на 2 тип. Последние 15-20 лет интерес к выбору оптимальной терапии на всех этапах развития СД 2 типа возрастает. Это связано с одной стороны с появлением новых научных данных, а с другой стороны со всё увеличивающимися возможностями фармакологического воздействия у этой категории больных. В настоящее время специалисты выделяют 9 групп таблетированных и инъекционных препаратов. Эти данные представлены в одном из самых важных опубликованных за последнее время международных документов ? совместном консенсусе Американской Диабетической Ассоциации (ADA) и Европейской Ассоциации по исследованию диабета (EASD), а также в недавно опубликованном Консенсусе Американской Ассоциации Клинических Эндокринологов (AACE)/ Американской Коллегии Эндокринологов (ACE). В этом обзорном документе специально оговаривается сравнение различных препаратов в виде следующего заявления: в настоящее время недостаточно данных, чтобы поддержать рекомендацию по какому-то конкретному классу сахароснижающих препаратов или их комбинации в отношении влияния на предупреждение осложнений. Поэтому, справедливо судить и сравнивать сахароснижающие агенты, так же, как и их сочетание, в первую очередь по их способности снижать и поддерживать уровень HbA1c, а также по их безопасности, специфическим побочным эффектам, переносимости, удобстве в применении?. Далее в документе подчеркивается особая роль инсулина в лечении СД, обосновывая это следующим: ? инсулин является самым мощным сахароснижающим препаратом; ? своевременное начало инсулинотерапии обеспечивает оптимальный контроль гликемии и, соответственно, улучшает прогноз СД 2 типа, замедляя развитие в организме необратимых изменений; ? доказано влияние интенсивной инсулинотерапии на предупреждение развития сосудистых осложнений при диабете; ? по мере прогрессирования диабета заболеванием труднее управлять; в этом плане инсулин даёт дополнительные преимущества, поскольку его действие не зависит от остаточной секреторной активности бета-клеток. В настоящих рекомендациях будут затронуты все этапы инсулинотерапии СД 2 типа: начало, оптимизация и интенсификация.

Methods for guantificative assessment of insulin resistance

The article delineates the definition of concept of insulin resistance as well as the factors that determine tissue insulin sensitivity; defines the conception of «insulin resistance syndrome» (metabolic syndrome), its criteria and diseases that it accompanies. It is pointed that the golden standard for quantitative assessment of insulin action is hyperinsulinemic euglycemic clamp. Different indexes for indirect measurement of insulin resistance and possibilities of use of mathematical models for this matter are discussed.

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.