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).

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

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.

О б з о р ы л и т е р а т у р ы Н арушения водно-солевого баланса нередко определяют симптоматику и тяжесть течения многих заболеваний. В клинической прак-тике одной из причин синдрома полиурии-полидип-сии является центральный несахарный диабет (ЦНД) с распространенностью 1 случай на 25 000 человек, в различных популяциях она варьирует от 0,004% до 0,01%, ежегодный показатель заболеваемости со-ставляет 3-4 случая на 100 тыс. населения [6,18,19]. Это заболевание несколько чаще встречается у мужчин (60% от числа всех пациентов с ЦНД) [28].ЦНД (за исключением острых потерь жидкости) является частой формой первичной дегидратации, в основе которой лежит дефицит антидиуретического гормона (АДГ, вазопрессина) [2,9,18]. Несмотря на относительную редкость, ЦНД требует особого внимания, поскольку представляет собой тяжелую патологию гипоталамо-гипофизарной системы, несу-щую угрозу жизни без адекватной терапии вследствие исключительной роли АДГ в водно-солевом обмене. Нарушение водно-солевого баланса при ЦНД прояв-ляется снижением почечной реабсорбции воды и выде-лением большого количества мочи с низким удельным весом; как следствие уменьшается содержание воды в организме и компенсаторно резко увеличивается по-требление жидкости [7,8,26].Совместно с нейрогуморальными воздействи-ями и другими гормонами (предсердный натрийу-ретический гормон, альдостерон, ангиотензин II), АДГ контролирует экскрецию или задержку соли и воды почками. Главный стимул для усиления секре-ции АДГ -это повышение осмоляльности плазмы. Этот эффект опосредуется через активацию осморе-цепторов, чувствительных к колебаниям осмоляль-ности. Быстрое увеличение осмоляльности плазмы на 1-2% приводит к усилению секреции АДГ в 4 раза, в то время как уменьшение на 2% сопровождается по-давлением его секреции [2,7].ФГБОУ ВО МГМСУ им. А.И. Евдокимова Минздрава России, Москва Бирюкова Е.В.* Центральный несахарный диабет (ЦНД) -тяжелая патология гипоталамо-гипофизарной системы, в основе которой лежит дефицит антидиуретического гормона (АДГ). Заболевание несет в себе потенциальную опасность для жизни без адекватной заместительной терапии препаратами аргинин-вазопрессина. В данном обзоре представлены современные данные об этиоло-гии, патогенезе и клинико-диагностических аспектах лечения центрального несахарного диабета. Приведены сравнительные фармакологические характеристики различных препаратов десмопрессина для лечения центральной формы заболевания. При выборе средства терапии центрального несахарного диабета в статье отмечена долгосрочная высокая эффективность и безопасность оригинальной сублингвальной формы выпуска десмопрессина (Минирин Мелт), подтвержденная в условиях реальной практики и рамках клинических исследований, в том числе и в сравнении с другими лекарственными формами десмопрессина. Ключевые слова: центральный несахарный диабет, вазопрессин, десмопрессин, минирин таблетки лиофилизат. Selection of desmopressin preparations for the treatment of central diabetes insipidus Biryukova E.V.* Moscow State University of Medicine and Dentistry named after A.I....

No abstract

Aim. To describe a role of self-monitoring of glycemia in a treatment of diabetes mellitus (DM) and in a prevention of vascular complications of DM. Materials and methods. Data of 57 scientific sources from Russian and foreign literature published within 2005-2017 are considered. Results and conclusions. DM is a chronic disease associated with a development of micro- and macrovascular complications and to prevent them is an important task of modern medicine. In patients with DM an incidence of cardiovascular diseases is 2-3 times higher compared with the general population. Hyperglycemia is among the major damaging factors for the cardiovascular system. Clinical studies have clearly demonstrated that programs of therapeutic management of diabetic patients which include regular self-monitoring of glycemia lead to a better reduction of glycated hemoglobin levels compared to programs without self-monitoring as well as they help many patients to avoid late complications. СКГ rate is correlated with glycated hemoglobin levels. Regular self-monitoring allows you to avoid sudden and dangerous fluctuations in glycemia, including hypoglycemia, which contribute to high cardiovascular risk. The use of self-monitoring of glycemia in combination with structured patient education is associated with improving the quality of life of patients with DM. Current view on self-monitoring implies a certain frequency of blood glucose systematic measurement (varies depending on the type of glucose-lowering therapy and the degree of diabetes compensation) and is an important reference point used by both the doctor and the patient to assess a treatment outcome and to correct it if necessary. An availability of modern glucometers and skills of their correct and regular use turn a patient into an active and valuable participant in a management of DM. Achieving and maintaining the target glycemia levels depends largely on an accuracy of the glucometer since measurement results provide the basis for changing a glucose-lowering therapy if necessary. From the physician's point of view, the most important criterion for selecting a glucometer is compliance with the accuracy standards, and from the patient’s point of view this is convenience and ease of use. Thanks to improving technologies that increases an accuracy of blood glucose measurements, the procedure for self-monitoring of glycemia is simplified, which contributes to glucose-lowering therapy effectiveness and treatment compliance.

Diabetes mellitus (DM) is a chronic disease associated with the development of micro-and macrovascular complications, prevention of which is an important task of modern medicine. Achieving and maintaining blood glucose levels close to normal, however, is almost impossible without the full participation of the patient in the treatment of diabetes. Self-monitoring of blood glucose (SAG) is the basis of the effectiveness of glucose-lowering therapy and prevention of hypoglycemia. This article discusses the recommended frequency of SCG depending on the type of diabetes. For measuring blood sugar at home now a variety of devices is available. Selection of quality meter is determined by ease of use, ease of operation of the device, ease of preparation and fair presentation of results of the results of measurement.

Maintaining glycemic control through intensive clinical management of patients with type 2 diabetes mellitus (T2DM) is well recognized to reduce the risk of diabetes-associated complications. Patients in Russia have high rates of microvascular and macrovascular complications as a result of undiagnosed, untreated, or inadequately treated diabetes, emphasizing the need for better clinical management. The introduction of basal insulin therapy is often necessary for patients with T2DM when oral antihyperglycemic drugs and lifestyle management strategies are no longer effective inmaintaining glycemic targets. However, after initiation of insulin, patients often remain on basal insulin for long periods despite suboptimal glycemic control, and intensification of insulin therapy is frequently necessary. Here, we report on several different insulin intensification strategies available to clinicians and their patients to improve glycemic control and the advantages and disadvantages of each approach. These strategies include the use of short- and long-acting insulins administered either as bolus doses or as premixed insulins. When selecting the most appropriate intensification strategy, clinicians should consider the lifestyle and treatment goals of their patients to help ensure treatment success.