M. S. Shamkhalova, O. K. Vikulova, A. V. Zheleznyakova, M. A. Isakov, M. V. Shestakova, I. I. Dedov, N. G. Mokrysheva
BACKGROUND : Chronic kidney disease (CKD) in diabetes mellitus (DM) is a supranosological concept that characterizes multifactorial kidney damage associated with increased cardiovascular and mortality risk, which determines the high medical and social significance of this problem in diabetic patients. AIMS : To assess the clinical and epidemiological characteristics of CKD in adult DM patients with type 1(T1) and type 2 (T2) in Russian Federation (RF) in 2010–2022 according to the Federal Register of Diabetes Mellitus (FDR) and to present the capabilities of the register’s analytical tools for assessing organ-protective therapy and predicting the risk of pathology. MATERIALS AND METHODS : We have used the database of FRD (http://diaregistry.ru), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022. RESULTS : The CKD prevalence in adult DM patients in RF in dynamics 2010→2022 showed in an increase in the rate for T1 from 21.5 to 27.1% (1.3 times), for T2 from 5.2 to 19.1% (3.7 times). The incidence of new CKD cases was 153.3→106.3/10 000 adult patients in T1, and 64.3→212.8/10 000 adult patients in T2. The analysis of the distribution by CKD stage indicates improved diagnosis of the complication. In the structure of new cases of CKD in the dynamics of 2010→2022. The proportions of patients with low and moderate combined risk of cardiovascular events and end-stage renal failure according to KDIGO criteria increased for T1 63.7→82.4%, for T2 64.5→77.4%. The proportions of patients with very high risk progressively decreased for T1 12.3→4.0%, for T2 13.1→1.6%. The average age of onset of CKD increased by an average of 6 years in persons with type 1 and type 2 diabetes (35.6→42 years, 63.3→69.3 years, respectively), with the dynamics of the average DM duration at the time of CKD development: in T1 11.5→14.8 years, in T2 7.4→7.8 years. The cause of terminal CKD in the structure of mortality in DM patients took only in T1 patients 5.6% and in T2D — 2.0%. A retrospective analysis of factors influencing the fatal outcome of DM patients with COVID-19 showed the significance of a history of CKD in T2DM patients, which increases the risk of death by 1.49 times (95% CI 1.01–2.04). Analysis of the structure of glucose-lowering therapy in T2DM patients and CKD indicates a more frequent prescription of drugs from the group of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor antagonists compared to the general cohort of T2DM. There is the CKD prognosis calculator in the FRD, which allows assessing the risk of developing of pathology within 5 years in a particular patient based on a set of the most significant predictors, which included 6 factors for T1 and 11 factors for T2. CONCLUSIONS: Epidemiological trends in the prevalence of CKD over a 13-year period indicate the growing importance of this problem in DM patients who are at risk. Along with the positive trends in the development of pathology with a lon
背景:糖尿病(DM)合并慢性肾脏疾病(CKD)是一个超病理学概念，其特征是多因素肾脏损害与心血管和死亡风险增加相关，这决定了该问题在糖尿病患者中的高度医学和社会意义。目的:根据联邦糖尿病登记册(FDR)，评估2010-2022年俄罗斯联邦(RF) 1型(T1)和2型(T2)成年DM患者CKD的临床和流行病学特征，并介绍登记册分析工具评估器官保护治疗和预测病理风险的能力。材料和方法:我们使用了FRD数据库(http://diaregistry.ru)， RF的85个区域。数据为2023年1月1日的动态数据，为2010-2022年的动态数据。结果:动态2010→2022年RF地区成年DM患者CKD患病率显示T1从21.5%增加到27.1%(1.3倍)，T2从5.2增加到19.1%(3.7倍)。T1期CKD新发发病率为153.3→106.3/万成人患者，T2期为64.3→212.8/万成人患者。对CKD分期分布的分析有助于提高并发症的诊断。在2010年→2022年CKD新发病例的动态结构中。符合KDIGO标准的低、中度心血管事件合并终末期肾功能衰竭患者比例在T1组增加63.7→82.4%，在T2组增加64.5→77.4%。非常高危患者的比例在T1阶段逐渐下降12.3→4.0%，T2阶段为13.1→1.6%。1型和2型糖尿病患者CKD的平均发病年龄平均增加了6岁(分别为35.6→42岁，63.3→69.3岁)，CKD发展时平均DM持续时间的动态变化:T1为11.5→14.8岁，T2为7.4→7.8岁。终末期CKD的病因在DM患者死亡结构中仅占T1患者的5.6%，占T2D患者的2.0%。对DM合并COVID-19患者致死性结局影响因素的回顾性分析显示，有CKD病史的T2DM患者死亡风险增加1.49倍(95% CI 1.01-2.04)。对T2DM患者和CKD降糖治疗结构的分析表明，与一般T2DM患者相比，SGLT-2抑制剂、DPP-4抑制剂和GLP-1受体拮抗剂组的药物处方更为频繁。FRD中有CKD预后计算器，它可以根据一组最重要的预测因素评估特定患者5年内发生病理的风险，其中包括6个T1因素和11个T2因素。结论:13年来CKD患病率的流行病学趋势表明，这一问题在处于危险中的DM患者中日益重要。随着糖尿病病程延长的病理发展的积极趋势，在临床实践中，CKD晚期肾功能受损的检测不及时的问题仍然存在。根据临床建议，病程的进行性和肾损害对患者过早死亡风险的负面影响决定了预防性诊断和治疗策略的优先级，这些策略旨在遵守检查标准，早期阶段的病理检测和多因素的肾保护方法。
{"title":"Trends in the epidemiology of chronic kidney disease in patients with diabetes in Russian Federation according to the Federal diabetes register (2010–2022)","authors":"M. S. Shamkhalova, O. K. Vikulova, A. V. Zheleznyakova, M. A. Isakov, M. V. Shestakova, I. I. Dedov, N. G. Mokrysheva","doi":"10.14341/dm13090","DOIUrl":"https://doi.org/10.14341/dm13090","url":null,"abstract":"BACKGROUND : Chronic kidney disease (CKD) in diabetes mellitus (DM) is a supranosological concept that characterizes multifactorial kidney damage associated with increased cardiovascular and mortality risk, which determines the high medical and social significance of this problem in diabetic patients. AIMS : To assess the clinical and epidemiological characteristics of CKD in adult DM patients with type 1(T1) and type 2 (T2) in Russian Federation (RF) in 2010–2022 according to the Federal Register of Diabetes Mellitus (FDR) and to present the capabilities of the register’s analytical tools for assessing organ-protective therapy and predicting the risk of pathology. MATERIALS AND METHODS : We have used the database of FRD (http://diaregistry.ru), 85 regions of the RF. The data are presented as of 01.01.2023 and in dynamics for the period 2010–2022. RESULTS : The CKD prevalence in adult DM patients in RF in dynamics 2010→2022 showed in an increase in the rate for T1 from 21.5 to 27.1% (1.3 times), for T2 from 5.2 to 19.1% (3.7 times). The incidence of new CKD cases was 153.3→106.3/10 000 adult patients in T1, and 64.3→212.8/10 000 adult patients in T2. The analysis of the distribution by CKD stage indicates improved diagnosis of the complication. In the structure of new cases of CKD in the dynamics of 2010→2022. The proportions of patients with low and moderate combined risk of cardiovascular events and end-stage renal failure according to KDIGO criteria increased for T1 63.7→82.4%, for T2 64.5→77.4%. The proportions of patients with very high risk progressively decreased for T1 12.3→4.0%, for T2 13.1→1.6%. The average age of onset of CKD increased by an average of 6 years in persons with type 1 and type 2 diabetes (35.6→42 years, 63.3→69.3 years, respectively), with the dynamics of the average DM duration at the time of CKD development: in T1 11.5→14.8 years, in T2 7.4→7.8 years. The cause of terminal CKD in the structure of mortality in DM patients took only in T1 patients 5.6% and in T2D — 2.0%. A retrospective analysis of factors influencing the fatal outcome of DM patients with COVID-19 showed the significance of a history of CKD in T2DM patients, which increases the risk of death by 1.49 times (95% CI 1.01–2.04). Analysis of the structure of glucose-lowering therapy in T2DM patients and CKD indicates a more frequent prescription of drugs from the group of SGLT-2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor antagonists compared to the general cohort of T2DM. There is the CKD prognosis calculator in the FRD, which allows assessing the risk of developing of pathology within 5 years in a particular patient based on a set of the most significant predictors, which included 6 factors for T1 and 11 factors for T2. CONCLUSIONS: Epidemiological trends in the prevalence of CKD over a 13-year period indicate the growing importance of this problem in DM patients who are at risk. Along with the positive trends in the development of pathology with a lon","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"5 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135460868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. I. Kondratyeva, A. I. Tlif, A. Yu. Voronkova, E. L. Amelina, N. Yu. Kashirskaya, S. A. Krasovsky, M. A. Starinova, T. L. Kuraeva
BACKGROUND : In recent decades, the life expectancy of patients with CF has increased, which leads to an increase in the frequency of conditions associated with impaired carbohydrate metabolism. AIM : to analyze the impact of cystic fibrosis-associated diabetes mellitus (CFDM) in children and adolescents on the course of cystic fibrosis according to the 2021 register of patients with cystic fibrosis of the Russian Federation (RF). MATERIALS AND METHODS : the data of the register of patients with cystic fibrosis of the Russian Federation for 2021 were analyzed. The study included 122 patients with diabetes mellitus requiring the use of insulin — 33 children (27%) and 89 adults (73%), the average age of children was 13.5±4.1, the average age of adult. patients aged 18 years and older was 27.4±6.6. To compare the course of cystic fibrosis in patients with and without diabetes mellitus, groups were formed that were comparable in age, gender, genotype — the group of patients without diabetes included 827 patients, 33 patients made up the group of patients with CFRD using insulin. Diagnostic criteria, indicators of respiratory function, microbiological status, nature of complications, volume of therapy were compared. RESULTS : Patients with CFRD have a lower FEV1 compared to children without diabetes mellitus — M±SD FEV1 (%) 85.2±27.5 in the group of patients without diabetes mellitus and M±SD FEV1 (%) 72.4±26.0 in patients with diabetes mellitus (p < 0.016), compared in the microbiological seeding groups — a trend towards more frequent chronic growth of Pseudomonas aeruginosa 54.50% versus 39.4% in the group without CFRD. An increase in MRSA was also more often detected — 9.1% compared with the group of children without diabetes — 3.1%. Antibacterial therapy is more commonly used — inhaled in 54.6% of patients without diabetes mellitus while children with CFRD received inhaled antibiotic therapy in 75.8% (p=0.017). There was a significant difference in the used antibacterial tablet therapy (p=0.013). A significant difference in the number of patients on oxygen therapy in the group with CFRD — 12.1%, versus 3.4% without CFRD (p=0.01) confirms a more severe course of cystic fibrosis in patients with CFRD. CONCLUSION : The prevalence of CFDM with the need for insulin therapy among children in the Russian Federation is 1.3%. Cystic fibrosis-associated diabetes mellitus significantly worsens the course of cystic fibrosis in terms of lung function, the growth of gram-negative and resistant flora, the presence of severe complications and the frequent use of antibiotic therapy, which is obviously associated with frequent exacerbations of the bronchopulmonary process in cystic fibrosis in patients with developed cystic fibrosis-associated diabetes mellitus.
{"title":"Characteristics of patients with cystic fibrosis-dependent diabetes mellitus in childhood according to the register of patients with cystic fibrosis of the Russian Federation in 2021","authors":"E. I. Kondratyeva, A. I. Tlif, A. Yu. Voronkova, E. L. Amelina, N. Yu. Kashirskaya, S. A. Krasovsky, M. A. Starinova, T. L. Kuraeva","doi":"10.14341/dm13064","DOIUrl":"https://doi.org/10.14341/dm13064","url":null,"abstract":"BACKGROUND : In recent decades, the life expectancy of patients with CF has increased, which leads to an increase in the frequency of conditions associated with impaired carbohydrate metabolism. AIM : to analyze the impact of cystic fibrosis-associated diabetes mellitus (CFDM) in children and adolescents on the course of cystic fibrosis according to the 2021 register of patients with cystic fibrosis of the Russian Federation (RF). MATERIALS AND METHODS : the data of the register of patients with cystic fibrosis of the Russian Federation for 2021 were analyzed. The study included 122 patients with diabetes mellitus requiring the use of insulin — 33 children (27%) and 89 adults (73%), the average age of children was 13.5±4.1, the average age of adult. patients aged 18 years and older was 27.4±6.6. To compare the course of cystic fibrosis in patients with and without diabetes mellitus, groups were formed that were comparable in age, gender, genotype — the group of patients without diabetes included 827 patients, 33 patients made up the group of patients with CFRD using insulin. Diagnostic criteria, indicators of respiratory function, microbiological status, nature of complications, volume of therapy were compared. RESULTS : Patients with CFRD have a lower FEV1 compared to children without diabetes mellitus — M±SD FEV1 (%) 85.2±27.5 in the group of patients without diabetes mellitus and M±SD FEV1 (%) 72.4±26.0 in patients with diabetes mellitus (p < 0.016), compared in the microbiological seeding groups — a trend towards more frequent chronic growth of Pseudomonas aeruginosa 54.50% versus 39.4% in the group without CFRD. An increase in MRSA was also more often detected — 9.1% compared with the group of children without diabetes — 3.1%. Antibacterial therapy is more commonly used — inhaled in 54.6% of patients without diabetes mellitus while children with CFRD received inhaled antibiotic therapy in 75.8% (p=0.017). There was a significant difference in the used antibacterial tablet therapy (p=0.013). A significant difference in the number of patients on oxygen therapy in the group with CFRD — 12.1%, versus 3.4% without CFRD (p=0.01) confirms a more severe course of cystic fibrosis in patients with CFRD. CONCLUSION : The prevalence of CFDM with the need for insulin therapy among children in the Russian Federation is 1.3%. Cystic fibrosis-associated diabetes mellitus significantly worsens the course of cystic fibrosis in terms of lung function, the growth of gram-negative and resistant flora, the presence of severe complications and the frequent use of antibiotic therapy, which is obviously associated with frequent exacerbations of the bronchopulmonary process in cystic fibrosis in patients with developed cystic fibrosis-associated diabetes mellitus.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"34 3-4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135461008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. V. Shestakova, G. R. Galstyan, E. N. Grineva, A. V. Zilov, T. Yu. Demidova, A. M. Mkrtumyan, N. A. Petunina, L. A. Ruyatkina, O. Y. Sukhareva, L. A. Suplotova, M. S. Shamkhalova
Over the past 10 years of studying the complications of type 2 diabetes mellitus (DM) and ways to deal with them, significant progress has been made in one of the most important areas of treatment — the prevention of cardiovascular and renal complications. Thus, when using inhibitors of type 2 sodium-glucose cotransporter, a significant reduction in the risks of cardiovascular mortality and progression of chronic heart failure, which occupy the main place in the structure of mortality in this cohort of patients, as well as a positive effect on diabetic nephropathy, one of the most common complications of type 2 diabetes, has been proven. However, there are other complications that significantly affect the duration and quality of life of patients. In particular, these include stroke, which occupies the 2nd-3rd place in the frequency of death of people with type 2 diabetes, and albuminuria, a frequent manifestation of diabetic kidney disease, which is associated with an increased risk of cardiovascular complications (including stroke) and chronic renal failure. Recent studies indicate the important role of sodium-glucose cotransporter type 1 in the development of these complications. Canagliflozin has the highest affinity for these transporters among iSGLT-2 registered in the Russian Federation. This article aims to evaluate the mechanisms of action of canagliflozin and its possible role in the prevention of stroke and albuminuria.
{"title":"The role of canagliflozin in the prevention of stroke and chronic kidney disease in patients with type 2 diabetes mellitus: an expert council resolution","authors":"M. V. Shestakova, G. R. Galstyan, E. N. Grineva, A. V. Zilov, T. Yu. Demidova, A. M. Mkrtumyan, N. A. Petunina, L. A. Ruyatkina, O. Y. Sukhareva, L. A. Suplotova, M. S. Shamkhalova","doi":"10.14341/dm13086","DOIUrl":"https://doi.org/10.14341/dm13086","url":null,"abstract":"Over the past 10 years of studying the complications of type 2 diabetes mellitus (DM) and ways to deal with them, significant progress has been made in one of the most important areas of treatment — the prevention of cardiovascular and renal complications. Thus, when using inhibitors of type 2 sodium-glucose cotransporter, a significant reduction in the risks of cardiovascular mortality and progression of chronic heart failure, which occupy the main place in the structure of mortality in this cohort of patients, as well as a positive effect on diabetic nephropathy, one of the most common complications of type 2 diabetes, has been proven. However, there are other complications that significantly affect the duration and quality of life of patients. In particular, these include stroke, which occupies the 2nd-3rd place in the frequency of death of people with type 2 diabetes, and albuminuria, a frequent manifestation of diabetic kidney disease, which is associated with an increased risk of cardiovascular complications (including stroke) and chronic renal failure. Recent studies indicate the important role of sodium-glucose cotransporter type 1 in the development of these complications. Canagliflozin has the highest affinity for these transporters among iSGLT-2 registered in the Russian Federation. This article aims to evaluate the mechanisms of action of canagliflozin and its possible role in the prevention of stroke and albuminuria.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"93 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135461007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. V. Pokrovskaya, E. A. Shestakova, M. V. Shestakova
BACKGROUND : One of the function of the endothelium is the maintenance of body's homeostasis. Endothelial dysfunction is known to be profoundly implicated in the pathogenesis of cardiovascular diseases (CVD). The presence of diabetes mellitus significantly increases the risks of CVD. Type 2 diabetes mellitus (T2DM) is often observed in obesity, however, there is a population of people with obesity, who do not develop T2DM for a long time. AIM : To compare the level of markers of endothelial dysfunction in two groups of individuals (without T2DM and with T2DM), as well as to evaluate the impact of cardioprotective medication (GPP-1 and SGLT-2) on these markers. MATERIALS AND METHODS : We recruited 2 groups of patients with obesity into this study: the 1st group with no carbohydrate metabolism disorders, the 2nd with T2DM. Several markers of endothelial dysfunction were evaluated: human von Willebrand factor (VWF), vascular endothelial growth factor A (VEGF-A), soluble form E-selectin (sE-selectin), soluble intercellular adhesion molecule-1 (sICAM1). RESULTS : A significant increase in sE-Selectin was seen in the group of patients with obesity and T2DM compared with those without carbohydrate metabolism disorders (46.65 [36.23; 66.66] vs 33.05 [22.1;53.31] ng/ml). There were no differences in the level of markers of endothelial dysfunction in the subgroups of patients with T2DM with HbA1c < 8% and >8%. There was also no effect of cardioprotective drugs (SGLT-2 and / or GPP-1) on any of endothelial dysfunction markers in individuals with T2DM. CONCLUSION : We suggest that an increase in sE-selectin may be an early marker of endothelial dysfunction in obese individuals and T2DM.
背景:内皮细胞的功能之一是维持机体的内稳态。内皮功能障碍被认为与心血管疾病(CVD)的发病机制密切相关。糖尿病的存在显著增加心血管疾病的风险。2型糖尿病(T2DM)常见于肥胖人群，但也有一部分肥胖人群长期不发展为T2DM。目的:比较两组个体(无T2DM和有T2DM)内皮功能障碍标志物的水平，并评估心脏保护药物(GPP-1和SGLT-2)对这些标志物的影响。材料与方法:我们招募了两组肥胖患者:第一组无碳水化合物代谢紊乱，第二组有T2DM。评估了几种内皮功能障碍的标志物:人血管性血液病因子(VWF)、血管内皮生长因子A (VEGF-A)、可溶性e-选择素(sE-selectin)、可溶性细胞间粘附分子-1 (sICAM1)。结果:与没有碳水化合物代谢障碍的患者相比，肥胖和T2DM患者组sE-Selectin显著升高(46.65 [36.23;66.66] vs 33.05 [22.1;53.31] ng/ml)。T2DM合并HbA1c和lt患者亚组中内皮功能障碍标志物水平无差异;8%和>8%在T2DM患者中，心脏保护药物(SGLT-2和/或GPP-1)对任何内皮功能障碍标志物也没有影响。结论:我们认为硒选择素的升高可能是肥胖和2型糖尿病患者内皮功能障碍的早期标志。
{"title":"Endothelial dysfunction in patients with obesity and type 2 diabetes mellitus or normoglycemia: assessment of specific markers","authors":"E. V. Pokrovskaya, E. A. Shestakova, M. V. Shestakova","doi":"10.14341/dm13088","DOIUrl":"https://doi.org/10.14341/dm13088","url":null,"abstract":"BACKGROUND : One of the function of the endothelium is the maintenance of body's homeostasis. Endothelial dysfunction is known to be profoundly implicated in the pathogenesis of cardiovascular diseases (CVD). The presence of diabetes mellitus significantly increases the risks of CVD. Type 2 diabetes mellitus (T2DM) is often observed in obesity, however, there is a population of people with obesity, who do not develop T2DM for a long time. AIM : To compare the level of markers of endothelial dysfunction in two groups of individuals (without T2DM and with T2DM), as well as to evaluate the impact of cardioprotective medication (GPP-1 and SGLT-2) on these markers. MATERIALS AND METHODS : We recruited 2 groups of patients with obesity into this study: the 1st group with no carbohydrate metabolism disorders, the 2nd with T2DM. Several markers of endothelial dysfunction were evaluated: human von Willebrand factor (VWF), vascular endothelial growth factor A (VEGF-A), soluble form E-selectin (sE-selectin), soluble intercellular adhesion molecule-1 (sICAM1). RESULTS : A significant increase in sE-Selectin was seen in the group of patients with obesity and T2DM compared with those without carbohydrate metabolism disorders (46.65 [36.23; 66.66] vs 33.05 [22.1;53.31] ng/ml). There were no differences in the level of markers of endothelial dysfunction in the subgroups of patients with T2DM with HbA1c < 8% and >8%. There was also no effect of cardioprotective drugs (SGLT-2 and / or GPP-1) on any of endothelial dysfunction markers in individuals with T2DM. CONCLUSION : We suggest that an increase in sE-selectin may be an early marker of endothelial dysfunction in obese individuals and T2DM.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"143 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135464116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. M. Kalandiya, L. P. Doronina, V. A. Mitish, A. Yu. Tokmakova, E. L. Zaitseva, G. R. Galstyan
BACKGROUND : Diabetic neuroosteoarthropathy is a disabling complication of diabetes mellitus that develops as a result of impaired peripheral innervation and characterized by damage to bones and joints of non-infectious origin. As a result of pathological bone fractures, gross deformities of the foot are formed, which entails development of chronic ulcerative defects in areas of excessive load pressure. Currently, a number of surgical interventions are used to correct deformities, such as resection of bone structures, correction with metal structures and external fixation devices, but there is practically no data on their long-term results in the domestic literature. AIM : To study the results of orthopedic corrective interventions in patients with diabetes mellitus and midfoot neuroosteoarthropathy. MATERIALS AND METHODS : An analysis was made the data collected by questionnaire method of 55 patients operated in the diabetic foot department in the Endocrinology research centre from 2009-2019. All patients underwent a reconstructive operation aimed correcting a gross deformity of the midfoot. In postoperative period, the affected limb was off-loaded by total contact cast for a period of 3-6 months, and in the future, complex orthopedic shoes for permanent use and regular podiatric care were recommended to patients. RESULTS : After the first surgical intervention, 16 patients developed a recurrence of deformity, which required a second surgical intervention. The median period between interventions was 3 years. Chronic wounds of various localization of the operated foot were found in 25 patients. The median period between surgery and ulcer formation was 5 years. 9 patients with chronic wounds underwent minor amputations at the same foot. Amputations on the contralateral limb were performed in 7 patients. None of the patients underwent major amputations. CONCLUSION : Charcot foot is a severe complication of diabetes mellitus that can lead to loss of a lower limb. Due to results of the research orthopedic corrections of the midfoot deformities in patients with DNOAP can reduce the risk of ulcer developement and possible major amputations. Active monitoring and adequate orthopedic care in the postoperative period significantly reduce the risk of deformity recurrence and the need for repeated surgical interventions.
{"title":"Long-term results of corrective surgical interventions in patients with diabetic midfoot neuroosteoarthropathy","authors":"M. M. Kalandiya, L. P. Doronina, V. A. Mitish, A. Yu. Tokmakova, E. L. Zaitseva, G. R. Galstyan","doi":"10.14341/dm13000","DOIUrl":"https://doi.org/10.14341/dm13000","url":null,"abstract":"BACKGROUND : Diabetic neuroosteoarthropathy is a disabling complication of diabetes mellitus that develops as a result of impaired peripheral innervation and characterized by damage to bones and joints of non-infectious origin. As a result of pathological bone fractures, gross deformities of the foot are formed, which entails development of chronic ulcerative defects in areas of excessive load pressure. Currently, a number of surgical interventions are used to correct deformities, such as resection of bone structures, correction with metal structures and external fixation devices, but there is practically no data on their long-term results in the domestic literature. AIM : To study the results of orthopedic corrective interventions in patients with diabetes mellitus and midfoot neuroosteoarthropathy. MATERIALS AND METHODS : An analysis was made the data collected by questionnaire method of 55 patients operated in the diabetic foot department in the Endocrinology research centre from 2009-2019. All patients underwent a reconstructive operation aimed correcting a gross deformity of the midfoot. In postoperative period, the affected limb was off-loaded by total contact cast for a period of 3-6 months, and in the future, complex orthopedic shoes for permanent use and regular podiatric care were recommended to patients. RESULTS : After the first surgical intervention, 16 patients developed a recurrence of deformity, which required a second surgical intervention. The median period between interventions was 3 years. Chronic wounds of various localization of the operated foot were found in 25 patients. The median period between surgery and ulcer formation was 5 years. 9 patients with chronic wounds underwent minor amputations at the same foot. Amputations on the contralateral limb were performed in 7 patients. None of the patients underwent major amputations. CONCLUSION : Charcot foot is a severe complication of diabetes mellitus that can lead to loss of a lower limb. Due to results of the research orthopedic corrections of the midfoot deformities in patients with DNOAP can reduce the risk of ulcer developement and possible major amputations. Active monitoring and adequate orthopedic care in the postoperative period significantly reduce the risk of deformity recurrence and the need for repeated surgical interventions.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135924967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
E. A. Shestakova, I. A. Sklyanik, A. S. Panevina, A. V. Yurasov, Yu. I. Yashkov, M. S. Sineokaya, A. O. Gavrilova, V. V. Evdoshenko, V. V. Fedenko, N. S. Bordan, M. V. Shestakova
There are several models for predicting remission of type 2 diabetes mellitus (T2D) a year after bariatric surgery — DiaRem, ABSD, IMS, etc. However, these models cannot be used to predict the early normalization of glycemia (within a few months after surgery). These models also do not include the assessment of insulin resistance (IR).AIM. To assess the effect of insulin resistance on the development of remission of T2D after bariatric surgery.METHODS: The study included 42 patients with T2D and severe obesity, who underwent bariatric surgery. Baseline assessment included hyperinsulinemic euglycemic clamp test (with the determination of the M-index (mg/kg/min), and evaluation of HOMA-IR index. Glycemia normalization was determined by self-monitoring (<6.1 mmol/l at fasting state and <7.8 mmol/l 2 hours after meals) as well as by HbA1c (<6.5%, starting 3 months after surgery). We used ROC analysis to determine the possibility of using IR indicators in predicting of the normalization of glycemia after bariatric surgery. The cut off value was determined using the Yuden criterion.RESULTS: All patients were severely insulin resistant. The median M-index before surgery was 1.535 mg/kg/min, the HO-MA-IR index was 10.0. During 1 year after surgery the increasing number of patients reached normal glycemia: 7 (16.7%) patients in 1 month, 22 (52.4%) patients after 3 months, 31 (73.8%) patients after 6 months, 35 (83.3%) patients after 12 months. In ROC analysis the optimal threshold the M-index was 1.876 mg/kg/min.CONCLUSION: The value of the M-index > 1.876 mg/kg/min can be used to predict the glycemia normalization early after bariatric surgery.
{"title":"M-index as a predictor of glycemia normalization in T2D patients early after bariatric surgery","authors":"E. A. Shestakova, I. A. Sklyanik, A. S. Panevina, A. V. Yurasov, Yu. I. Yashkov, M. S. Sineokaya, A. O. Gavrilova, V. V. Evdoshenko, V. V. Fedenko, N. S. Bordan, M. V. Shestakova","doi":"10.14341/dm13045","DOIUrl":"https://doi.org/10.14341/dm13045","url":null,"abstract":"There are several models for predicting remission of type 2 diabetes mellitus (T2D) a year after bariatric surgery — DiaRem, ABSD, IMS, etc. However, these models cannot be used to predict the early normalization of glycemia (within a few months after surgery). These models also do not include the assessment of insulin resistance (IR).AIM. To assess the effect of insulin resistance on the development of remission of T2D after bariatric surgery.METHODS: The study included 42 patients with T2D and severe obesity, who underwent bariatric surgery. Baseline assessment included hyperinsulinemic euglycemic clamp test (with the determination of the M-index (mg/kg/min), and evaluation of HOMA-IR index. Glycemia normalization was determined by self-monitoring (<6.1 mmol/l at fasting state and <7.8 mmol/l 2 hours after meals) as well as by HbA1c (<6.5%, starting 3 months after surgery). We used ROC analysis to determine the possibility of using IR indicators in predicting of the normalization of glycemia after bariatric surgery. The cut off value was determined using the Yuden criterion.RESULTS: All patients were severely insulin resistant. The median M-index before surgery was 1.535 mg/kg/min, the HO-MA-IR index was 10.0. During 1 year after surgery the increasing number of patients reached normal glycemia: 7 (16.7%) patients in 1 month, 22 (52.4%) patients after 3 months, 31 (73.8%) patients after 6 months, 35 (83.3%) patients after 12 months. In ROC analysis the optimal threshold the M-index was 1.876 mg/kg/min.CONCLUSION: The value of the M-index > 1.876 mg/kg/min can be used to predict the glycemia normalization early after bariatric surgery.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135925107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. B. Antsiferov, M. A. Kantemirova, N. A. Demidov, M. F. Kalashnikova
BACKGROUND : When developing programs for state reimbursement of the cost of medical services and medicines, when providing assistance to patients suffering from type 1 diabetes mellitus (DM1), data based on the results of pharmacoepide-miological studies (FEI) conducted in real clinical practice of treating patients are needed. The obtained results of the analysis of drug consumption allow us to study the most commonly used insulin therapy regimens and their compliance with modern clinical recommendations. Calculations of the weighted average cost of conducting hypoglycemic therapy in DM1 can be used for further pharmacoeconomical calculations, including analysis of the medical and social cost of the disease. AIM : To conduct a pharmacoepidemiological analysis of the consumption of insulin preparations according to the ATX /DDD methodology, to study the modes of insulin administration and the ratio of the weighted average cost of insulin therapy components per 1 patient with DM1 per year in the outpatient practice of treatment with the introduction of insulin in the mode of multiple injections of insulin (MII) and during continuous subcutaneous insulin infusion (CSII). MATERIALS AND METHODS : A retrospective continuous cohort analytical pharmacoepidemiological study was conducted on the basis of the SRDM database (status as of 01/01/2020), in which 17,617 patients with T1DM aged 18 years and older were registered at the time of the study. RESULTS : 90% of patients received analogues of human insulin in the MII mode using syringe pens, 8.6% used the CSII mode. In 34.5% of patients with DM1 HbA1c was <7%, the proportion of patients with HbA1c >8% was 28%. The average cost of insulin therapy per 1 person per year was 54,977 rubles. The cost of basal insulin treatment per 1 patient per year was approximately 1.5 times higher than the cost of bolus insulin during insulin therapy in the MII mode (33,960 rubles and 21,017 rubles, respectively). The weighted average cost of insulin per 1 patient per year for CSII was 31,822 rubles. CONCLUSION : The majority of patients with DM1 in the study cohort received analogues of human insulin in the basic bolus mode of MII using syringe pens, which corresponds to existing clinical recommendations. The proportion of patients achieving the goals of glycemic control is comparable to the data obtained on the basis of registers of diabetic patients in other economically developed countries
{"title":"Pharmacoepidemiological analysis of type 1 diabetes mellitus insulin therapy (According to the Moscow segment of the State Register of Diabetes Mellitus)","authors":"M. B. Antsiferov, M. A. Kantemirova, N. A. Demidov, M. F. Kalashnikova","doi":"10.14341/dm12962","DOIUrl":"https://doi.org/10.14341/dm12962","url":null,"abstract":"BACKGROUND : When developing programs for state reimbursement of the cost of medical services and medicines, when providing assistance to patients suffering from type 1 diabetes mellitus (DM1), data based on the results of pharmacoepide-miological studies (FEI) conducted in real clinical practice of treating patients are needed. The obtained results of the analysis of drug consumption allow us to study the most commonly used insulin therapy regimens and their compliance with modern clinical recommendations. Calculations of the weighted average cost of conducting hypoglycemic therapy in DM1 can be used for further pharmacoeconomical calculations, including analysis of the medical and social cost of the disease. AIM : To conduct a pharmacoepidemiological analysis of the consumption of insulin preparations according to the ATX /DDD methodology, to study the modes of insulin administration and the ratio of the weighted average cost of insulin therapy components per 1 patient with DM1 per year in the outpatient practice of treatment with the introduction of insulin in the mode of multiple injections of insulin (MII) and during continuous subcutaneous insulin infusion (CSII). MATERIALS AND METHODS : A retrospective continuous cohort analytical pharmacoepidemiological study was conducted on the basis of the SRDM database (status as of 01/01/2020), in which 17,617 patients with T1DM aged 18 years and older were registered at the time of the study. RESULTS : 90% of patients received analogues of human insulin in the MII mode using syringe pens, 8.6% used the CSII mode. In 34.5% of patients with DM1 HbA1c was <7%, the proportion of patients with HbA1c >8% was 28%. The average cost of insulin therapy per 1 person per year was 54,977 rubles. The cost of basal insulin treatment per 1 patient per year was approximately 1.5 times higher than the cost of bolus insulin during insulin therapy in the MII mode (33,960 rubles and 21,017 rubles, respectively). The weighted average cost of insulin per 1 patient per year for CSII was 31,822 rubles. CONCLUSION : The majority of patients with DM1 in the study cohort received analogues of human insulin in the basic bolus mode of MII using syringe pens, which corresponds to existing clinical recommendations. The proportion of patients achieving the goals of glycemic control is comparable to the data obtained on the basis of registers of diabetic patients in other economically developed countries","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135925106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. V. Rusyaeva, I. I. Golodnikov, I. V. Kononenko, T. V. Nikonova, M. V. Shestakova
The course of difficult-to-classify types of diabetes mellitus (DM) (slowly developing immune-mediated DM of adults (LADA), monogenic forms of DM (MODY)) has common features with both type 1 DM (T1DM) and type 2 DM (T2DM), so often remain misdiagnosed. Errors in determining the type of diabetes lead to incorrect treatment tactics, which leads to poor glycemic control, the development of complications, a decrease in the patient's quality of life, and increased mortality. The key method for diagnosing MODY is sequencing of genes associated with this disease, and LADA is an immunological blood test in combination with the features of the clinical picture. However, the exact criteria for referring patients to these studies have not yet been determined. Performing these studies on all patients without exception with risk factors can lead to unjustified economic costs, and access to them is often difficult. In this regard, various automated algorithms have been developed based on statistical methods and machine learning (deep neural networks, “decision trees”, etc.) to identify patients for whom an in-depth examination is most justified. Among them are algorithms for the differential diagnosis of T1DM and T2DM, algorithms specializing in the diagnosis of only LADA or only MODY, only one algorithm is aimed at multiclass classification of patients with diabetes. One of the algorithms is widely used, aimed at diagnosing MODY in patients under the age of 35 years. However, existing algorithms have a number of disadvantages, such as: small sample size, exclusion of patients with MODY or older patients from the study, lack of verification of the diagnosis using appropriate studies, and the use of late complications of diabetes as parameters for diagnosis. Often the research team did not include practicing physicians. In addition, none of the algorithms are publicly available and have not been tested for patients in Russia. This manuscript presents an analysis of the main automated algorithms for the differential diagnosis of diabetes, developed in recent years.
{"title":"Machine learning methods in the differential diagnosis of difficult-to-classify types of diabetes mellitus","authors":"N. V. Rusyaeva, I. I. Golodnikov, I. V. Kononenko, T. V. Nikonova, M. V. Shestakova","doi":"10.14341/dm13070","DOIUrl":"https://doi.org/10.14341/dm13070","url":null,"abstract":"The course of difficult-to-classify types of diabetes mellitus (DM) (slowly developing immune-mediated DM of adults (LADA), monogenic forms of DM (MODY)) has common features with both type 1 DM (T1DM) and type 2 DM (T2DM), so often remain misdiagnosed. Errors in determining the type of diabetes lead to incorrect treatment tactics, which leads to poor glycemic control, the development of complications, a decrease in the patient's quality of life, and increased mortality. The key method for diagnosing MODY is sequencing of genes associated with this disease, and LADA is an immunological blood test in combination with the features of the clinical picture. However, the exact criteria for referring patients to these studies have not yet been determined. Performing these studies on all patients without exception with risk factors can lead to unjustified economic costs, and access to them is often difficult. In this regard, various automated algorithms have been developed based on statistical methods and machine learning (deep neural networks, “decision trees”, etc.) to identify patients for whom an in-depth examination is most justified. Among them are algorithms for the differential diagnosis of T1DM and T2DM, algorithms specializing in the diagnosis of only LADA or only MODY, only one algorithm is aimed at multiclass classification of patients with diabetes. One of the algorithms is widely used, aimed at diagnosing MODY in patients under the age of 35 years. However, existing algorithms have a number of disadvantages, such as: small sample size, exclusion of patients with MODY or older patients from the study, lack of verification of the diagnosis using appropriate studies, and the use of late complications of diabetes as parameters for diagnosis. Often the research team did not include practicing physicians. In addition, none of the algorithms are publicly available and have not been tested for patients in Russia. This manuscript presents an analysis of the main automated algorithms for the differential diagnosis of diabetes, developed in recent years.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135924952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND : Postprandial hyperglycemia (PPG) is associated with micro- and macrovascular diseases in patients with T2DM. Severity of postprandial peaks depends on composition and amount of food. Circadian rhythms can influence PPG, which may determine variability of glycemia during day. According to literature, in persons without T2DM, PPG is maximum after dinner. Features of the postprandial response in patients with T2DM are not effective enough. AIM : To assess variability of postprandial glycemia based on flash glucose monitoring (FGM) depending on meal times in patients with T2DM not receiving insulin. MATERIALS AND METHODS : Open prospective study. T2DM patients were managed on FMG FreeStyle Libre. Each patient carried out 9 tests with three types of food loads: boiled buckwheat (250 grams), apple (200 grams) and white bread (30 grams) for breakfast, lunch and dinner. Statistical analysis of PPG by area under glycemic curve (AUC) and area under glycemic curve excluding starting glycemia (delta AUC), analysis of glycemia before meals (Start_gly) was carried out. Effect of time of food intake and food type was assessed with a two-way RM ANOVA using R 4.1.2. for quantitative variables, arithmetic means and standard deviations (M±SD) are presented. RESULTS : A total of 29 patients were included. Data from 17 patients, 153 food loading tests, were included in analysis. Both food type (p=0.037) and time of food intake (p=0.003) were shown to have a significant effect on the AUC. Maximum AUC values were observed after breakfast (p=0.005 vs supper, p<0.001 vs dinner), and buckwheat intake (p=0.01 vs apple). For the delta AUC only type of food (p=0.003) had significant influence. Delta AUC was higher for buckwheat than for apple (p=0.001) and wheat bread (p=0.012). CONCLUSION : Patients with T2DM who do not receive insulin have higher PCG levels after breakfast compared to lunch and dinner, regardless of the type of food load. Rise in glucose after a food load relative to initial values does not significantly differ from time of a meal, which does not coincide with known data on the maximum rise in glycemia on a food stimulus after dinner, which is observed in individuals without DM2.
{"title":"Effect of meal time on postprandial glycemia in patients with type 2 diabetes mellitus and obesity not receiving insulin","authors":"I. V. Misnikova, D. E. Zoloeva, A. A. Glazkov","doi":"10.14341/dm13023","DOIUrl":"https://doi.org/10.14341/dm13023","url":null,"abstract":"BACKGROUND : Postprandial hyperglycemia (PPG) is associated with micro- and macrovascular diseases in patients with T2DM. Severity of postprandial peaks depends on composition and amount of food. Circadian rhythms can influence PPG, which may determine variability of glycemia during day. According to literature, in persons without T2DM, PPG is maximum after dinner. Features of the postprandial response in patients with T2DM are not effective enough. AIM : To assess variability of postprandial glycemia based on flash glucose monitoring (FGM) depending on meal times in patients with T2DM not receiving insulin. MATERIALS AND METHODS : Open prospective study. T2DM patients were managed on FMG FreeStyle Libre. Each patient carried out 9 tests with three types of food loads: boiled buckwheat (250 grams), apple (200 grams) and white bread (30 grams) for breakfast, lunch and dinner. Statistical analysis of PPG by area under glycemic curve (AUC) and area under glycemic curve excluding starting glycemia (delta AUC), analysis of glycemia before meals (Start_gly) was carried out. Effect of time of food intake and food type was assessed with a two-way RM ANOVA using R 4.1.2. for quantitative variables, arithmetic means and standard deviations (M±SD) are presented. RESULTS : A total of 29 patients were included. Data from 17 patients, 153 food loading tests, were included in analysis. Both food type (p=0.037) and time of food intake (p=0.003) were shown to have a significant effect on the AUC. Maximum AUC values were observed after breakfast (p=0.005 vs supper, p<0.001 vs dinner), and buckwheat intake (p=0.01 vs apple). For the delta AUC only type of food (p=0.003) had significant influence. Delta AUC was higher for buckwheat than for apple (p=0.001) and wheat bread (p=0.012). CONCLUSION : Patients with T2DM who do not receive insulin have higher PCG levels after breakfast compared to lunch and dinner, regardless of the type of food load. Rise in glucose after a food load relative to initial values does not significantly differ from time of a meal, which does not coincide with known data on the maximum rise in glycemia on a food stimulus after dinner, which is observed in individuals without DM2.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135924951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. V. Shestakova, V. A. Dobronravov, A. S. Ametov, M. B. Antsiferov, M. M. Batyushin, I. N. Bobkova, G. R. Galstyan, T. Y. Demidova, V. V. Klimontov, A. M. Mkrtumyan, N. A. Petunina, E. I. Prokopenko, N. V. Chebotareva, M. S. Shamkhalova
Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is one of the most important medical and social problems associated with significant risks for patients and a burden on the national healthcare system. There are significant unmet diagnostic and therapeutic needs of CKD in T2D patients in Russia relating to problems of underdiagnostics of CKD and substantial residual cardiorenal risks in these patients in spite of therapy with registered renoprotective medications. Finerenone is the first selective non-steroidal mineralocorticoid receptor antagonist which targets different from other drugs pathways involved in the pathogenesis of CKD in T2D. It has a significant potential to reduce residual renal and CV risks, and therefore addresses the existing therapeutic unmet need. According to the results of recent clinical studies, the cardio- and renoprotective effects of finerenone were apparent throughout a wide range of CKD C1-C4 in T2D patients, regardless of the severity of kidney dysfunction, the level of HbA1c and other drug therapy. This document summarizes the main results regarding the efficacy and safety profiles of finerenone and determines its place in treatment of CKD in T2D patients.
{"title":"Prospects of finerenone use in Russian population of patients with chronic kidney disease and type 2 diabetes. Resolution of multidisciplinary. Advisory board","authors":"M. V. Shestakova, V. A. Dobronravov, A. S. Ametov, M. B. Antsiferov, M. M. Batyushin, I. N. Bobkova, G. R. Galstyan, T. Y. Demidova, V. V. Klimontov, A. M. Mkrtumyan, N. A. Petunina, E. I. Prokopenko, N. V. Chebotareva, M. S. Shamkhalova","doi":"10.14341/dm13020","DOIUrl":"https://doi.org/10.14341/dm13020","url":null,"abstract":"Chronic kidney disease (CKD) in patients with type 2 diabetes (T2D) is one of the most important medical and social problems associated with significant risks for patients and a burden on the national healthcare system. There are significant unmet diagnostic and therapeutic needs of CKD in T2D patients in Russia relating to problems of underdiagnostics of CKD and substantial residual cardiorenal risks in these patients in spite of therapy with registered renoprotective medications. Finerenone is the first selective non-steroidal mineralocorticoid receptor antagonist which targets different from other drugs pathways involved in the pathogenesis of CKD in T2D. It has a significant potential to reduce residual renal and CV risks, and therefore addresses the existing therapeutic unmet need. According to the results of recent clinical studies, the cardio- and renoprotective effects of finerenone were apparent throughout a wide range of CKD C1-C4 in T2D patients, regardless of the severity of kidney dysfunction, the level of HbA1c and other drug therapy. This document summarizes the main results regarding the efficacy and safety profiles of finerenone and determines its place in treatment of CKD in T2D patients.","PeriodicalId":11327,"journal":{"name":"Diabetes Mellitus","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135924953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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