Aim. To determine the effects of hypoglycemia on the duration of QT interval, heart rate variability (HRV) and frequency of arrhythmic events, as well as to closer investigate the factors associated with the development of various heart rhythm disorders in children and adolescents with type 1 diabetes mellitus (T1DM). Materials and methods.  The study included 150 children and adolescents with T1DM at the age of 6?18 years. All participants underwent Holter monitoring and continuous glucose monitoring (CGM) for 24 hours. QTc and HRV parameters (SDNN, RMSSD, SVVR) were calculated automatically. Data was averaged for 5?-interval and juxtaposed with CGM. Patients identified with hypoglycemic events (blood glucose

Повышение ригидности артериальной стенки у детей и подростков с сахарным диабетом 1 типа и автономной дисфункцией Лаптев Д.Н. ФГБУ Эндокринологический научный центр, Москва(директор -академик РАН И.И. Дедов) 15,7 [14,3; 17,3] лет, длительность СД 6 [2,6; 10] Цель. Определение связи жесткости магистральных артерий с кардиоваскулярной формой автономной нейропатии (КАН) у детей и подростков с сахарным диабетом 1 типа (СД1

ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава России, Москва ОБОСНОВАНИЕ. Данные регистра являются основным источником информации о пациентах с сахарным диабетом (СД) для повышения качества организации лечебной и профилактической помощи.ЦЕЛЬ. Провести анализ эпидемиологических характеристик СД (распространенности, заболеваемости, смертности) у детей и подростков в РФ по данным Федерального регистра СД, оценить динамику данных параметров за период 2013-2016 гг., состояние углеводного обмена, структуру инсулинотерапии, частоту госпитализаций и частоту разви-тия диабетических осложнений в данных возрастных группах. . Заболеваемость СД1 у детей в 2016 г. составила 14,2/100 тыс. д.н., у подростков -10,0/100 тыс. п.н. Распределе-ние по уровню HbA 1c у пациентов с СД1 в 2016 г: дети: <7,5% -32%, 7,6-9,0% -33%, >9% -35%; подростки: <7,5% -25%, 7,6-9,0% -30%, >9% -45%. Среди осложнений у детей и подростков наиболее часто регистрируется диабетическая нейропатия при СД1 в 10,9% и 40,8% случаев, при СД2 -в 4,7% и 8,8% соответственно, из сопутствующих заболева-ний -артериальная гипертония и дислипидемия. Госпитализировались в анамнезе 43,8% детей и 49,2% подростков, большинство госпитализаций в 2016 г. (дети 71,9%, подростки 67,1%) было по причине СД.ЗАКЛЮЧЕНИЕ. Установлено, что в динамике 2013-2016 гг. сохраняется рост распространенности СД1 у детей при от-носительно стабильных показателях у подростков. По данным регистра, в последние два года отмечено снижение темпов заболеваемости СД1 и, напротив, рост заболеваемости СД2 у детей. Установлены значительные межрегиональ-ные различия в уровне заболеваемости и распространенности СД в регионах, расположенных в различных геогра-фических областях РФ. Частота диабетических осложнений у детей и подростков с СД варьирует. Установлена четкая связь частоты госпитализаций с выраженностью декомпенсации СД. В структуре терапии данной возрастной группы соотношение инсулинотерапии в шприцах-ручках и помповой терапии по данным регистра составляет 80,9%/15,1%.КЛЮЧЕВЫЕ СЛОВА: сахарный диабет; эпидемиология; дети; подростки; распространенность; заболеваемость; смертность DIABETES MELLITUS IN CHILDREN AND ADOLESCENTS ACCORDING TO THE FEDERAL DIABETES REGISTRY IN THE RUSSIAN FEDERATION: DYNAMICS OF MAJOR EPIDEMIOLOGICAL BACKGROUND:The data of the register is the main source of up-to-date information about patients with diabetes mellitus (DM). It's very important for improving the quality of medical care organization.

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RATIONALE: Continuous subcutaneous insulin infusion (CSII) is an effective method for optimizing glycemic control in children with type 1 diabetes mellitus (DM1). However, the use of CSII does not always result in adequate glycemic control. Telehealth can be applied as one of the methods to improve the effectiveness of treatment.AIMS: To evaluate the use of remote medical support of children and adolescents with DM1 and its influence on glycemic control, quality of life, and incidence of acute complications of DM1.MATERIALS AND METHODS: We conducted a 24-week multi-institutional prospective open-label controlled clinical trial. 180 children and adolescents were included in this study and divided into the following categories: 1) age 8–18 years; 2) DM1 at least 1 year; 3) pump insulin therapy Medtronic Paradigm (Medtronic MiniMed, USA) at least 6 months; 4) self-monitoring of glycemia at least 4 times a day and replacement of the insulin pump infusion system at least once every 3 days; 5) inadequate glycemic control of DM1: the level of glycated hemoglobin (HbA1c) 7.5% or higher. Patients were assigned to a remote consultation group (RC; n=100) or a traditional control group (TC; n=80). All patients were trained on the basic principles of DM1 and CSII, and we measured initial HbA1c, then after 12 and 24 weeks, also registered and analyzed glycemic indicators and daily doses of insulin, evaluated and corrected the treatment. Patients or their parents in the RC group sent pump data via the Internet to the pump insulin therapy center at least once every 2 weeks at home and received treatment recommendations in response.RESULTS: The total number of patients included in the study in all institutions was 180 children at 8–18 years. Patients in both groups did not differ in age, gender, duration of DM1 and CSII, and HbA1c level. The total amount of remote consultations for all institutions was 949. The decrease in the level of HbA1c by the end of the study against the initial one was statistically significantly greater in the RC group: 1.17% compared to 0.59% in the TC group (p<0.05). The proportion of patients who reached the target level of HbA1c (<7.5%) was significantly higher in the RC group (32%) compared to the TC group (12.5%, p<0.05). During the study, the incidence of DKA and severe hypoglycemia in the RC group was statistically significantly lower.CONCLUSIONS: Remote monitoring in children with DM1 resulted in significant improvements in glycemic control (HbA1c, glycemic variability, and hypoglycemic frequency). The accumulation of evidence on the effectiveness and safety of telehealth in DM should contribute to implementing this approach in practical health care.

Dear Colleagues! We are glad to present the 9th Edition (revised) of Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation. The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the Standards also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals. Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045. Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) Type 2 DM, 6% (256 202) Type 1 DM and 2% (89 870) other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they dont receive any treatment ant have high risk of vascular complications. Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death. In сurrent edition of the Standards: New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given. Added a snippet that describes the continuous glucose monitoring. Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism. Proposes more stringent target levels of blood pressure. It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion. In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages. Recommendations for psychosocial support are added. The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated. Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added. For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation. This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums. These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM. On behalf of the Working Group

Aim. Glucose variability (GV) and hypoglycaemia frequency and duration, depending on cardiovascular autonomic dysfunction, in children and adolescents with type 1 diabetes mellitus (T1DM) were evaluated. Materials and methods. One hundred and thirty T1DM patients, aged 6?18 years, were included in this study. The study included 3 tests:. continuous glucose monitoring (CGM) with GV evaluation, frequency and duration of hypoglycaemia;24-h ECG monitoring with automatic calculation of QTc interval and heart rate variability (HRV) parameters;cardiovascular autonomic tests.Results. The estimated prevalence of cardiovascular autonomic neuropathy (CAN) was 19.2%. CAN positive (CAN+) patients had lower values from cardiovascular autonomic tests and HRV and longer QTc intervals compared with CAN negative (CAN-) patients (p

Adequate glycemic control remains an unresolved problem for children and adolescents with type 1 diabetes mellitus. The use of new insulin analogsand intense insulinotherapy does not always permit to achieve the target levels of glycemia and HbA1c. To-day insulin pump therapy is considered tobe the most efficacious tool for the improvement of glycemic control.Aim. To estimate results of glycemic control in children and adolescents treated by insulin pump therapy. Materials and methods. The study included 173 patients aged 1.5-22 years having the disease for 0.5-20 years. MiniMed 508, MiniMed 712,MiniMed 722, Accu Check Spirit, Accu check D-Tron, Dana Care IIs pumps, ultrashort-acting insulins aspart and lispro were used. The patientsperformed self-control of glycemia 4-8 times during 24 hours. HbA1c was measured before and 12, 24, 36, 48 months after the onset of therapy. Thefrequency of DKA and severe hypoglycemia was recorded. Results. The HbA1c before the onset of therapy was 9.8 ?2.0% and dropped to 8.6; 8.7; 8.7; 8.9 and 9% 12, 24, 36, 48 months after it respectively.DKA was diagnosed in 20 (2.4%) and severe hypoglycemia in 5 patients. All patients in the CSII group were content with the use of the pumps, theabsence of injections and flexible day regimen. Conclusion. One year after the beginning of therapy the level of HbA1c significantly decreased. However, it increased again during a follow-up of5 years probably because of impaired compliance. This fact implies the necessity to regular repeat patient education for raising awareness of and motivationfor self-management.