Type 2 diabetes prevalence is growing in Russia and worldwide. To date disease is considered as the leading cause ofmortality in many countries. To date, there is a need to develop integrated program of type 2 diabetes and prediabetes early detection and care. Within Advisory council experts developed recommendations regarding program plan including activities on type 2 diabetes early screening, prevention and care. The Public Screening Program for Adult Population is currently being implemented in Russia and should be considered as a background for activities on type 2 diabetes early prevention.
Diabetes mellitus (DM) and chronic liver disease (CLD) are pathological conditions associated with each other and reaching epidemic proportions. There is a strong pathogenetic relationship of carbohydrate metabolism disorders and a number of CLD. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various CLD, leading to steatosis, insulin resistance (IR), impaired glucose tolerance and the development of DM are described. Effective glycemic control can have a beneficial effect on the treatment of these patients, and, conversely, there is evidence of a positive effect of CLD therapy on carbohydrate metabolism. This review discusses the correction of carbohydrate metabolism in patients with CLD, the main groups of modern hypoglycemic drugs, mechanisms of their action, the impact on the physiology of the liver, the possibility of using each of these pharmacological groups in patients with impaired liver function. The modern approaches and possibilities of drug effects on the process of fibrogenesis in CLD, the effect of these drugs on carbohydrate metabolism are listed.
Non-alcoholic fatty liver disease (NAFLD) affected 20-40% of the adult population in high developed countries. Active form of the disease - non-alcoholic steatohepatitis (NASH) - is characterized by damaged hepatocytes, inflammation of the liver tissue, can be accompanied by liver fibrosis, and is one of the most common causes of liver cirrhosis, liver failure and hepatocellular carcinoma. Moreover, there is a close link between NASH and metabolic syndrome, thereby among this category of patients the high risk of developing diabetes mellitus, cardiovascular complications and cancer. Weight reduction of 10% by observing dietary recommendations and performing regular physical exercises contributes to the reduction or complete resolution of NASH in some patients. However, in practice, it is not always possible to eliminate inflammation in the hepatic tissue. Existing drugs such as vitamin E, pioglitazone and pentoxifylline have limited efficacy, and can cause a few side effects, including hepatotoxicity, and not to reduce the severity of liver fibrosis. However, basic and translational studies have improved our understanding of the pathogenesis of NASH, thereby opening new promising therapeutic targets. Currently, several drug agents are in Phase II and Phase III clinical trials and may enter practice in the foreseeable future. In this article, we consider modern concepts of pathogenesis, existing therapeutic approaches and new directions of pharmacy in the field of NASH treatment.
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