Liudmila I. Ibragimova

BACKGROUND . Patients with type 1 diabetes mellitus (T1DM) are prone to earlier development of sarcopenia due to insulin deficiency, hyperglycemia, oxidative stress, and mitochondrial dysfunction. A pressing challenge in the management of these patients is the search for standardized diagnostic tools for the timely detection and monitoring of sarcopenia. OBJECTIVE . Comparative assessment of laboratory serum myokine levels in relation to muscle mass, strength, and function in postmenopausal women with type 1 diabetes and controls without diabetes. MATERIALS AND METHODS . A single-center, cross-sectional comparative study was conducted in women with type 1 diabetes (n=40) and a control group (n=40) aged 50–75 years. The SARC-F questionnaire, laboratory parameters (myostatin, follistatin, cystatin C, lipocalin 2, IGF-1), muscle mass (iDXA densitometry), strength (wrist dynamometry), and function (short-form exercise battery) were assessed. Statistical processing was performed in Statistica 14.0.0.15, IBM SPSS Statistics 23 using the Mann-Whitney, Fisher, and Spearman correlation tests. RESULTS . The age of the patients was 60 [56;64] years in the T1DM group and 64 [60;66] years in the control group (p=0.029). Glycated hemoglobin (HbA _1c ) in the T1DM group was 8.0% [7.6;9.3] with a diabetes duration of 26 [13;42] years. The myostatin level was significantly higher in T1DM 52.73 [46.45;58.26] mg/ml versus 21.46 [19.07;24.74] in the control (p < 0.001) and positively correlated with HbA _1c (r=0.544, p < 0.001), but not with muscle strength and mass. HbA1c negatively correlated with the time it took to get up from a chair 5 times. No differences were found in the levels of follistatin, lipocalin 2, cystatin C. Wrist dynamometry strength and walking speed were lower in the T1DM group with a tendency to statistical significance. The median IGF-1 was lower in diabetes (92.7 vs. 114.1 ng/ml, p=0.014) and positively correlated with muscle strength (r=0.472, p < 0.001). The sarcopenia index negatively correlated with muscle strength (r=-0.402, p=0.021) and positively with HbA _1c (r=0.514, p=0.035). Severe sarcopenia (according to EWGSOP2) was diagnosed in only one patient with T1DM, whose myostatin level did not differ from the range of patients without sarcopenia. CONCLUSION . Thus, patients with type 1 diabetes have higher myostatin levels, which correlates with with the level of HbA _1c . Low functional capacity in patients with type 1 diabetes is associated with HbA _1c levels, but is not directly related to myostatin levels.

Telehealth is becoming increasingly relevant and in demand as a technologically advanced area in healthcare. The telehealth approach in the management of patients with diabetes mellitus (DM) has the potential to improve disease management. Objective. To analyze the effectiveness of telehealth methods in correcting the level of glycated hemoglobin in patients with type 1 and type 2 diabetes mellitus. Materials and methods. We searched for meta-analyses with the keywords “telehealth” AND “diabetes” AND “meta-analysis” in the MEDLINE database (PubMed) and the words “telemedicine”, “diabetes”, “meta-analysis” in the RSCI database (eLibrary) until March 1, 2025. Results. The analysis includes 19 papers evaluating the use of telehealth technologies for the treatment of patients with diabetes. The effectiveness of telehealth in reducing the level of glycated hemoglobin ranged from –0.18% to –0.64% compared to traditional control (face-to-face visits of patients). Conclusion. Telehealth technologies can be effective in reducing glycated hemoglobin levels in patients with type 1 and type 2 diabetes mellitus; however, additional studies on the clinical and cost-effectiveness of telehealth monitoring are required to justify its wider introduction into practice.

Objective. To evaluate clinical and economic effectiveness of remote glycemic monitoring (RGM) in patients with type 1 and type 2 diabetes mellitus (DM) receiving non-insulin therapy in the Russian Federation. Material and methods. Cost-effectiveness analysis implied comparison of RGM with routine monitoring of adults with DM. Direct medical costs for treating DM and its complications were estimated in Markov model. Life-years saved was used as effectiveness criterion. The incremental cost-effectiveness ratio (ICER) was calculated in rubles per year of life saved for RGM compared with routine monitoring. ICER was compared with willingness-to-pay threshold equal to three times the per capita gross domestic product for 2024. The modeling time horizon was 5 years. Results. ICER for DM relative to routine practice was RUB 3.135.234.88 per life-year gained in patients with type 2 diabetes receiving non-insulin therapy, and RUB 3.146.031.73 per life-year gained in patients with type 1 diabetes that is below willingness-to-pay threshold (RUB 4.129.433.70). Conclusion. Cost-effectiveness analysis demonstrates clinical and economic effectiveness of RGM in patients with type 1 and type 2 diabetes receiving non-insulin therapy over a 5-year period.

Multiple endocrine neoplasia type 1 (MEN-1) is a rare hereditary disorder characterized by the development of multifocal tumors in endocrine organs. This article presents a clinical case of a female patient with a confirmed MEN1 mutation (c.203delC p.T70fsX118), who exhibited manifestations of various syndrome components over more than 10 years, including parathyroid adenomas, pancreatic neuroendocrine tumors, and a pituitary microprolactinoma. The patient underwent multiple surgical interventions: duodenopancreatectomy, parathyroidectomy with autotransplantation, adrenal resection, and esophageal leiomyoma removal. The study discusses the challenges in diagnosing the primary source of parathyroid hormone secretion, the difficulties in achieving optimal glycemic control due to absolute insulin deficiency following fulminant diabetes mellitus development after total pancreatectomy, as well as aspects of reproductive health and quality of life. This case highlights the importance of a personalized approach and multidisciplinary management in patients with MEN-1 syndrome.

BACKGROUND: There has been an increasing focus on the use of digital systems for remote monitoring (RM) of patient health recently. AIM: To evaluate the clinical effectiveness of the RM system in patients with type 1 and type 2 diabetes (T1D and T2D) compared to traditional outpatient care. MATERIALS AND METHODS: a non-randomized prospective open comparative multicenter study with parallel groups was conducted in 7 regions of the Russian Federation from March to September 2024. The study included patients with T1D, T2D on non-insulin therapy, and T2D on insulin therapy. The intervention group used a glycaemia RM system, which included a glucometer with a data transmission set, a mobile application that received data from the glucometer via Bluetooth technology, and a data transmission system for the doctor. In the control group, glycemia was assessed as part of routine clinical practice (in-person visits with a self-monitoring diary). RESULTS: A total of 1,572 patients were included in the study. After a 180-day follow-up, the overall completion rate was 48% (754 patients). The primary endpoint, HbA1c levels, decreased comparably in the RM and control groups in patients with T1DM and in both cohorts of patients with T2DM. The proportion of individuals who achieved HbA1c target values was higher in the RM group compared to the control group in patients with T1DM (26.06% vs. 10.91%, respectively, p=0.023) and T2DM on non-insulin therapy (51.5% vs. 33%, respectively, p=0.003). RM use was associated with a reduction in unscheduled medical interventions. CONCLUSION: RM has shown clinical efficacy in increasing the proportion of patients achieving HbA1c target values in the group of patients with T1D and T2D on non-insulin antidiabetic therapy.

Continuous glucose monitoring (CGM) has been established as a method for self-assessment glucose levels in individuals with diabetes mellitus in the Russian Federation for more than 15 years. The main characteristics of CGM sensors are its’ accuracy and performance that ensure their effectiveness and safety. Currently, there are no standardized guidelines that outline the minimum accuracy standards for CGM systems.This review is aimed to codify the current methods for evaluating CGMs accuracy and performance across the different countries, as well as to propose local Russian guidelines on CGM device accuracy evaluation. This involves guidelines for the design of clinical trials to assess sensors accuracy and the minimum acceptable performance requirements for CGM devices to be utilized in clinical settings.

The present article contains the newest ant the most actual version of clinical recommendations “Gestational diabetes mellitus” of the Russian Ministry of Health. This document has been confirmed for the period from 2024 until 2026 year. Gestational diabetes mellitus is widely known as onset of hyperglycaemia during pregnancy that does not responds to criteria of manifesting diabetes mellitus (DM). The time of next revision is 2026 year or earlier if new evidentiary material appear. The present version of clinical recommendation has been created due to collaboration between Russian Association of Endocrinologists and Russian Society of Obstetricians and Gynecologists. The document is finally approved by scientific and practical Council of the Russian Ministry of Health.

«И снова в школу» — программы обучения больных с сахарным диабетом

Artificial hypoglycemia (Munchausen syndrome) is a condition caused by low blood glucose due to the deliberate taking of insulin or oral hypoglycemic drugs. Artificial hypoglycemia remains one of the problems that endocrinologists face in their practice; a diagnostic search for its etiological factor can lead to expensive and unnecessary studies. Diagnosis of artificial hypoglycemia in patients with diabetes mellitus on insulin therapy seems to be a labor-intensive task, since unlike most factitious disorders, which may be indicated by atypical manifestations of the disease or conflicting medical information about the patient, in patients with diabetes mellitus hypoglycemic syndrome is an expected unwanted event due to insulin therapy. Therefore, deliberate insulin administration is often not diagnosed until self-induced hypoglycemia becomes recurrent and/or severe. If artificial hypoglycemia is suspected, a number of authors currently recommend testing С peptide and a combination of two methods for quantitative determination of insulin in the blood using different analyzer systems. Active collaboration between clinical and laboratory specialists is the key to successfully solving such a diagnostic problem.This article presents a clinical case of Munchausen syndrome in a 28-year-old patient with type 1 diabetes mellitus with recurrent hypoglycemia during 21 years, repeated severe hypoglycemia, including loss of consciousness, and proven intentional administration of an insulin analog drug during hospital stay; the complex diagnostic path passed before making the correct diagnosis is described.

BACKGROUND: Self-monitoring of blood glucose (SMBG) is the main tool to achieve carbohydrate metabolism targets in patients with type 1 diabetes mellitus (DM). Remote monitoring of SMBG in Russia appeared relatively recently and needs to be evaluated for effectiveness.AIM: To evaluate the effect of remote monitoring of SMBG on carbohydrate metabolism and quality of life in patients with type 1 DM in order to form new therapeutic approaches.MATERIALS AND METHODS: Patients with type 1 DM with glycated hemoglobin (HbA1c) from 8.0 to 12.0% were divided into the main (n=107) and control group (n=20). Patients from the main group performed SMBG using glucometers with the possibility of remote data transmission, patients from the control group continued the traditional SMBG. The dynamics of HbA1c, derived time spent in the target ranges, recognition of hypoglycemia (GOLD scale, Clarke questionnaire), quality of life according to the SF-36 questionnaire were evaluated. The statistical analysis was carried out in the SPSS Version 26.0 program (IBM, USA).RESULTS: In the main group (n=88) the HbA1c was statistically significant decreased after 6 months from 9.0% [8.4; 9.9] to 8.1% [7.4; 9.2] (pCONCLUSION: Remote monitoring of SMBG is a prospective therapeutic approach due to its positive effect on carbohydrate metabolism and quality of life in patients with type 1 DM.