Hyperglycemia in the period of acute stroke aggravates prognosis of its outcome in the patients with type 2 diabetes mellitus (DM2). The objective of the present study was to compare the effectiveness and safety of intravenous and subcutaneous ad- ministration of insulin to the patients presenting with DM2 in the period of acute stroke for the achievement of the same target blood glucose level of 7.8-10.0 mmol/l. At admission, the patients were randomized into two groups to be treated either with intravenous (n=36) or subcutaneous (n=37) injections of insulin. Intravenous insulin therapy resulted in a more favourable dynamics of the clinical course of the stroke patients estimated based on the National Institute of Health stroke scale (NIHSS) (p<0.001) and the activity of daily living (ADL) index (p<0.01). Moreover, it was associated with a reduced variability of glyce- mia (p<0.01) and a lower frequency of hypoglycemic episodes (p=0.019) compared with subcutaneous injections.

Objective. To evaluate the importance of determining fasting glycemia at the first prenatal visit for timely diagnostics of gesta- tional diabetes mellitus (GDM). Material and methods. The study included 577 pregnant women examined with the use of the oral glucose tolerance test (OGTT) during weeks 24-28 of pregnancy. The results of the test were compared with the fasting glucose level at the first prenatal visit. Results. The mean fasting blood glucose level at the first prenatal visit was 4.70±0.61 mmol/l. In 25% of the patients, fasting glycemia at this time was 5.1 mmol/l or higher. Only in 36% of the women (52 of the145 ones) with the fasting blood glucose level ≥5.1 and <7 mmol/l at the first prenatal visit, the results of OGTT were consistent with the criteria for GDM. The mean fasting blood glucose level at the first prenatal visit (up to week 16) was significantly higher than on weeks 24-28 (4.71±0.61 and 4.53±0.69 mmol/l respectively, p<0.001). The ROC analysis failed to reveal the fasting blood glucose level that could be used to predict the development of gestational diabetes with a reliable sensitivity and specific- ity. Conclusion. Further population-based investigations are needed to elucidate the relationship between fasting glycemia in the first trimester of pregnancy and its unfavourable outcome.

Objective. To estimate the prevalence of the cardiovascular form of autonomous neuropathy (CAN) and the factors associated with this condition in the adolescents suffering from type 2 diabetes mellitus (DM2) in comparison to the adolescents present- ing with type 1 diabetes mellitus (DM1). Material and methods. The study included 24 adolescents with DM2 and 30 ones with DM1 matched for the age, duration of the disease, and the quality of its compensation. The control group was comprised of 17 adolescents with exogenous constitutional obesity (ECO). All the patients were examined by means of Holter ECG monitoring with the estimation of the daily cardiac rhythm variability based on the mean weighted variation of rhythmogram (MWVR) and the length of the QTc interval. In addition, standard cardiovascular tests were performed including deep-breath test, the Valsalva maneuver, and the 30:15 intermittent fitness test. Cardiovascular autonomous neuropathy was diagnosed in the patients exhibiting deviation from the normal values in 3 of the five parameters of interest, viz. MWVR, QTc length, and three functional tests. Results. CAN at the subclincal stage was more frequently diagnosed in the adolescents with DM2 than in those suffering DM1 (29.2 and 10% of the cases respectively; p<0.05). This condition was not found in any of the patients presenting with endogenous constitutional obesity. MWVR in the adolescents with DM2 was lower than in the patients with DM1 (p=0.02) or ECO (p=0.04). The QTc duration was greater in the DM2 patients than in the adolescents of the same age presenting with ECO (p=0.02) and comparable with that in the patients suffering DM1 (p=0.3). In the adolescents with DM2, positive correlation between CAN, the duration of diabetes, the quality of its compensation, and the patient’s age was documented while the length of the QTc interval negatively correlated with these three variables. Moreover, the occurrence of CAN positively correlated with peripheral neuropathy. No relationship with the severity of insulin resistance was observed.

Type 2 diabetes mellitus (DM2) is known to be associated with the accelerated development of atherosclerosis. The current concepts of atherosclerosis take into consideration the possible role of inflammation in its pathogenesis which theoretically implies the modification of macrophages in accordance with the proinflammatory phenotype and the production of the proinflammatory cytokine tumour necrosis factor-alpha (TNF-α) by these cells. In connection with this, we undertook a study of spontaneous and induced secretion of proinflammatory cytokine TNF-α by monocytes-macrophages from the blood of 20 patients presenting with newly diagnosed type 2 diabetes mellitus (HbA1c - 8,9%) and the healthy volunteers showing up no disturbances of carbohydrate metabolism. It was shown that blood monocytes-macrophages of the patients presenting with DM2 are characterized by the enhanced ability (compared with the cells from the healthy subjects) to synthesize TNF-α in both native and interferon-y stimulated states up to 750 versus 270 pg/ml culture medium and to 1653 pg/ml versus 378 pg/ml culture respectively. This difference was statistically significant (p <0.05). It is concluded that the results of the study help to explain the elevated blood TNF-α level in the patients with type 2 diabetes mellitus and provide an insight into the mechanism underlying the development of the systemic inflammatory reaction accelerating the progression of atherosclerosis associated with diabetes mellitus.

The authors describe a rare case of parathyroid cancer characterized by the obscure clinical picture of hyperparathyroidism and subtotal ingrowth of the tumour through the right lobe of the thyroid gland.

IPEX syndrome (X-linked immune dysregulation, polyendocrinopathy, enteropathy) is one of the rare hereditary X-linked forms of neonatal diabetes mellitus associated with mutations in the FOXP3 gene. The disease is characterized by the combination of polyendocrinopathy (more frequently neonatal diabetes mellitus) with enteropathy and immune dysregulation. In the majority of the cases it has an unfavourable prognosis. The present article presents for the first time in the Russian-speaking literature the description of the genetically verified case of IPEX syndrome.

The excessive body weight and obesity in the men of the reproductive age exert the negative influence on their reproductive system and can promote the development of infertility. The high prevalence of obesity and the reduction of the birth rate in the developed countries stimulate the extensive investigations into the mechanisms by which the excess adipose tissue affects male fertility. The authors overview the literature publications concerning the hormonal profile and the adipokine level, as well as disturbance of spermatogenesis in the men with disordered fat metabolism with special reference to the peculiarities of the management of infertility with the application of the assisted reproductive technologies.

Despite the well-proved relationship between obesity and a number of chronic diseases, the information about the influence of the body weight on the life expectancy is contradictory. A wealth of literature publications deal with the paradoxical relation of the survival rate to obesity that manifests itself among the patients with the elevated body mass index (BMI) and moderate obesity as opposed to the patients having the normal or lowered BMI. The American Association of Endocrinologists proposed the new paradigm of the evaluation of BMI and obesity. The consensus of the Russian specialists as regards this paradigm needs to be reached in conjunction with the development of the relevant guidelines for practicing healthcare providers.

Iodine deficiency is known to be a major cause leading to the development of diffuse goiter. The available data indicate the existence of natural iodine deficiency over the entire territory of the Russian Federation. Nevertheless, there is up to now no legislative regulation of prophylaxis of iodine-deficiency diseases in the country by means of universal table salt iodization. Iodine-deficiency disorders are believed to currently affect 10-15% and 13-35% of the urban and rural populations of Rus- sia respectively. Calcium iodide preparations are widely applied to treat and prevent diffuse goiter in the patients including children, pregnant and breast-feeding women.

Type 2 diabetes mellitus (DM2) morbidity has increased over the past years. Its rapid growth affects young subjects among those of other age groups including adolescents and pre-pubertal children. The diseases develops in the association with obesity and metabolic syndrome but remains asymptomatic during a long period. Therefore, its detection requires an active diagnostic search. The present clinical recommendations highlight the major problems pertaining to the diagnostic and treatment strategies for the management of the patients presenting with type 2 diabetes mellitus.