Vol 67, No 1 (2012)

According to the WHO and the UN definitions, diabetes mellitus is a non-infectious disease that has an epidemic spread rate, this has led to the UN 2006 resolution against diabetes mellitus. A special diabetologic service has been established in Russia which includes Federal and regional diabetes centres, endocrinologic clinics, equipped with modern diagnostic and treatment equipment for diabetes and its vascular complications handling. Planning of diabetologic service functioning is based on State diabetes mellitus register data, according to which nowadays in Russia 3 268 871  patients have been registered. This article contains data from control-and-epidemiological studies from various regions of Russia which have shown real spread of the disease. This article also contains information about innovative technologies of treatment of diabetes mellitus and its complications, international and national foreground studies, as well as discussion of diabetologic service development perspectives.

In the recent years there has been registered an increase in diabetes mellitus (DM) morbidity, especially among able-bodied citizens. The steady increase in amount of DM patients inevitably leads to the increase in the amount of diabetic CHD patients – candidates for the surgical myocardial revascularization. This article contains analysis of choice of myocardial revascularization technique in patients with CHD and concomitant DM. It also contains data from the study of endovascular and surgical treatment of CHD results in diabetic patients. This study also included postoperative complications analysis with exposure of complication development predictors and was held in Bakulev Scientific Centre of cardiovascular surgery. Results obtained in the study testify to the fact that DB increases relative risk of cardio-vascular complications (cardiac death, myocardial infarction and restenosis of special-purposed stenosis) development in patients with CHD after percutaneous coronary intervention with stenting. DM is an independent risk factor that increases myocardial infarction development risk, recurrence of stenocardia and shunt failure during the three year follow up after the coronary artery bypass grafting done in CHD patients.

This article deals with peculiarities of development and clinical course of heart failure (HF) in diabetic patients, influence of diabetic cardiopathy on HF formation., role of genetic predictors of diabetes mellitus (DM) and HF formation, also the importance of treatment response predictors, the significance of a more «personalized» exposure in order to optimize treatment. The role of stationary and dynamic genomics was analyzed,
especially molecular visualization that allows the earliest possible intervention. The article also includes examples of molecular visualization use in diagnosis of myocardial dysfunction, disease monitoring, and treatment efficacy assessment. Authors give an analysis of targeted treatment methods on the example of targeted delivery of medications to the target-organ (myocard). Discuss means of anti-ischemic myocardial protection, perspectives of metformin use in order to enhance efficacy of myocardial ischemic pre- and postconditioning mechanisms. Presented perspectives of study of molecular and genetic mechanisms involved in the pathogenesis of HF in diabetic patients, in particular, study of key biological features of stem cells, cell interactions, stem cell plasticity (in vitro direction of differentiation) and their paracrine function evaluation. Given information about identification of genes with partly altered expression due to chronic exposure of mesenchymal stem cells to the high concentration of glucose, and upon decreased ability of mesenchymal stem cells of proangiogenic factors with simultaneous increase of inflammatory markers production (IL8). In whole this article reviews modern state of HF in diabetic patients development mechanisms study with the use of molecular and genetic technologies, and of perspectives of development of this area.

Diabetic nephropathy (DN) – is a leading cause of terminal renal failure in the developed countries. Kidney pathology development undergoes several
stages – from preclinical structural changes in the first years of the disease to diffuse or nodular glomerulosclerosis 15-20 years after the diabetes onset. Microalbuminuria is an early marker of DN. Intensive treatment of DN at the stage of microalbuminuria leads to regress and remission of lab parameters of DN in 40 – 50 % of patients after 2 years of treatment. Prognostic factors of DN remission are: tight glycaemia control, arterial hypertension control, especially while treated with renin-angiotensin blockers. Regress of structural changes of kidney tissue In a diabetic patient is possible only after a long-term (>10yrs) normoglycaemia maintenance.

The review covers the role of transplantology in treatment of patients with type 1 diabetes and the state of its development in the world and in Russia. The results of major multicenter studies, devoted to the influence of simultaneous kidney and pancreas transplantation and kidney transplantation alone on life expectancy and quality of life of diabetic patients are summarized here. Experience in pancreas-kidney transplantation, gained in Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, is described, including surgical technical and postoperative treatment. Also we perform the results of research work, devoted to the influence of pancreas transplantation on different homeostasis parameters, such as: oxidative stress parameters, homocysteine, receptor for advanced glycation endproduct (RAGE), and markers of endocrine function of pancreas transplant.

In Siberia and in the Far East region overall incidence of diabetes mellitus is somewhat lower than in the European part of the country, though these indices reduplicate on average in 10-15 years. The prevalence of both diabetes (both types) and metabolic syndrome among indigenous mongoloid population is lower than among Caucasian.

The paper is dedicated to clinical and laboratory aspects of Diabetes Mellitus non-immune forms, such as neonatal Diabetes Mellitus, Maturity Onset Diabetes of young (MODY), DIDMOAD-syndrome, Wolframe syndrome, Alstrom syndrome and its determinating genes. The analysis of proper clinical results are present in this paper.