Vol 94, No 10 (2022)

Cover Page

Full Issue


Obesity and diabetes – are they always together?

Shestakova M.V., Shestakova E.A., Sklyanik I.A., Stafeev I.S.


Obesity and type 2 diabetes mellitus (DM 2) are two interrelated metabolic diseases widespread throughout the developed world. However, up to 30% of individuals with a long history of obesity do not have a carbohydrate metabolism disorder. This article presents the results of a multi-year study of adipose tissue biology in obese individuals with DM 2 compared with individuals with the same history of obesity without DM 2. Comparative analysis of hormonal, cellular, and genetic factors in two groups of patients showed that DM 2 occurs in individuals with abnormal proliferation and adipogenic differentiation of mesenchymal stem cells (MSCs) of adipose tissue. It leads to adipocyte hypertrophy and inflammatory infiltration of adipose tissue macrophages, resulting in increased insulin resistance and diabetogenic effects. These disorders are due to abnormal expression of genes responsible for the proliferation and adipogenic differentiation of MSCs. The study of the possible reversibility of abnormal changes in adipose tissue MSCs in obese patients after significant weight loss and DM 2 remission appears to be a promising research direction. The ability to control adipose tissue progenitor cells may represent a new target for treating and preventing metabolic disorders in obesity.

Terapevticheskii arkhiv. 2022;94(10):1131-1135
pages 1131-1135 views

Original articles

The role of systemic immune activation in the development of thyroid dysfunction in COVID-19

Kolpakova E.A., Elfimova A.R., Nikankina L.V., Troshina E.A.


Background. The research of cytokine-induced thyropathies in the midst of continuing coronavirus infection (COVID-19) pandemic is a very important and urgent problem. On the one hand, COVID-19 is often accompanied by a massive overproduction of cytokines, so we can expect an enhanced cytokines effects impact on the thyroid gland. On the other hand, it is possible that biological therapy with tocilizumab, which has a powerful immunosuppressive effect, plays a protective role to the development of cytokines-induced thyropathies amidst COVID-19. The results of the study should be the starting point for understanding the mechanisms of possible compromise of thyroid function during COVID-19.

Aim. The primary endpoint is to assess the relationship between the levels of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) with the inflammatory process markers. The secondary endpoint is the identification of an association between TSH, FT3 and FT4 values, and patient survival.

Materials and methods. This retrospective, single-center study included 122 patients hospitalized at the National Medical Research Center for Endocrinology with a clinical and laboratory analysis of COVID-19 and bilateral polysegmental viral pneumonia. To assess the functional status of the thyroid gland all patients underwent observation of the TSH, FT3, FT4, antibodies to thyroid peroxidase, antibodies to the TSH receptor (AT-recTSH). The markers of the inflammatory process were assessed: interleukin-6, C-reactive protein, the degree of lung tissue damage according to multispiral computed tomography of the lungs, the percentage of blood oxygen saturation (SpO2), the treatment outcomes.

Results. Five (4%) patients were found with subclinical thyrotoxicosis. Serum TSH values were inversely correlated with interleukin-6 (r=-0.221; p=0.024). Analysis of the level of hospital mortality, stratified by TSH, revealed statistically significantly lower TSH values in the group of deceased patients (p=0.012). The median TSH in surviving patients was 1.34 [0.85; 1.80], for the deceased 0.44 [0.29; 0.99].

Conclusion. Our research shows that the trigger of thyropathies in coronavirus infection is most likely thyroid tissue damage by the proinflammatory cytokines. This study shows some specific clinical aspects regarding the clinical relevance in patients with thyrotoxicosis and COVID-19, namely, the high hospital mortality rate.

Terapevticheskii arkhiv. 2022;94(10):1136-1142
pages 1136-1142 views

Adipokines and the cardiorespiratory system in young patients with type 1 diabetes mellitus

Vengrzhinovskaya O.I., Bondarenko I.Z., Shatskaya O.A., Nikankina l.V., Kalashnikov V.Y., Shestakova M.V., Mokrysheva N.G.


Early screening of complications of diabetes mellitus (DM) is one of the priorities for public health. Most patients with type 1 diabetes mellitus (T1DM) are patients of working age. New strategies for the primary prevention of cardiovascular disease (CVD) are needed to prevent their early disability.

Aim. To assess the predictive value of adipokines in relation to a personalized approach to the need for an in-depth examination of young patients with T1DM.

Materials and methods. The study included 98 patients without CVD: 70 patients with T1DM (mean age 26.4±8.1 years) and 28 patients without DM (mean age 27±9 years). All patients underwent a general clinical examination, the levels of adipokines were determined, ergospirometry, echocardiography, and bioimpedancemetry were performed.

Results. Changes in the cardiorespiratory system in patients with T1DM were revealed, in comparison with persons without T1DM: anaerobic threshold was reached faster (p=0.001), maximum oxygen consumption was lower (p=0.048), metabolic equivalent was reduced (p=0.0001). Signs of myocardial remodeling were found in the T1DM group: there was an increase in the relative wall thickness (p=0.001), the posterior wall of the left ventricle (p=0.001), myocardial mass index (p=0.049), in comparison with persons without T1DM. Changes in the adipokines system were revealed: higher levels of resistin (p=0.002) and visfatin (p=0.001), lower level of adiponectin (p=0.040) in T1DM. A positive correlation was found between posterior wall of the left ventricle and visfatin (p=0.014) and a negative relationship between adiponectin and relative wall thickness (p=0.018) in T1DM.

Conclusion. In T1DM, even at a young age, there are multifactorial changes in the heart, which can be detected even at the preclinical stage. The data obtained can be used to identify groups of patients at high risk of developing dangerous CVD in T1DM, which can form the basis for determining the timing of the start of preventive therapy.

Terapevticheskii arkhiv. 2022;94(10):1143-1148
pages 1143-1148 views

Body composition in sarcopenia in middle-aged individuals

Samoilova I.G., Matveeva M.V., Khoroshunova E.A., Kudlay D.A., Tolmachev I.V., Spirina L.V., Mosienko I.V., Yun V.E., Trifonova E.I., Zakharchuk P.I., Vachadze T.D., Shuliko L.M., Galiukova D.E., Mutalimi V.E.


Sarcopenia is characterized by a progressive loss of muscle mass, strength, and function, leading to poor outcomes and reduced quality of life. In middle age, the decrease in muscle mass begins to be progressive. Bioimpedancemetry allows diagnosing this condition before the onset of clinical symptoms.

The purpose of the study: to evaluate the parameters of body composition in the early diagnosis of sarcopenia in middle-aged people.

Materials and Methods: The participants were divided into two groups – the main one with sarcopenia – 146 people and the control group – 75 people. The complex of examinations included: neuropsychological testing (Hospital Anxiety and Depression Scale (HADS), quality of life questionnaire for patients with sarcopenia (SarQoL), short health assessment form (SF-36)), 4-meter walking speed test, dynamometry and bioimpedancemetry.

The results of neuropsychological examination did not differ in the main and control groups. Patients with sarcopenia showed a decrease in muscle strength according to dynamometry. The scores of the walking speed assessment test in the study group were significantly higher than in the control group. The main and control groups had excessive body weight. According to the results of bioimpedanceometry, the main group had increased fat mass, percentage of fat mass, visceral fat area, and fat mass index compared with the control group. Skeletal muscle mass was less in the main group, probable sarcopenia was confirmed by decreased appendicular mass, decreased protein and mineral content was also recorded. There was a more pronounced decrease in cell mass in the main group. In patients with sarcopenia the volume of intracellular and extracellular fluid was less than in the control group. Significant differences were considered at p<0.05.

Conclusions: the introduction of bioimpedancemetry and dynamometry into early screening for muscle mass reduction will allow timely start of therapeutic and preventive measures even in middle age, which will lead to a decrease in the progression of sarcopenia in the elderly, as well as improve the quality of life.

Terapevticheskii arkhiv. 2022;94(10):1149-1154
pages 1149-1154 views

Non-alcoholic fatty liver disease and type 2 diabetes mellitus: general approaches to the choice of therapy

Petunina N.A., Telnova M.E., Goncharova E.V., Martirosian N.S., Kuzina I.A.


Currently, there is a growing interest in one of the most common diseases in hepatology – non-alcoholic fatty liver disease (NAFLD). There is evidence that approximately 75% of cases of NAFLD occur against the background of obesity, dyslipidemia or type 2 diabetes mellitus (T2DM). At the present stage, a persistent pathophysiological interaction between NAFLD and T2DM has been demonstrated. Insulin resistance is one of the main pathogenetic causes of the development of T2DM and NAFLD. At the same time, it is necessary to highlight the role of the intestinal microbiota and epigenome in the manifestation and progression of NAFLD. Therefore, treatment approaches should be comprehensive. Diet therapy should be aimed at calorie restriction. However, in real clinical practice, phisicians face a low commitment to appropriate and long-term dietary recommendations necessary for weight loss. At the same time, use of dietary fibers, which are part of the preparation Mucofalk, helps to slow down the passage of food through the digestive tract, increase the saturation period. Use of a low-calorie diet with a significant fat restriction may increase the risk of gallstones. Ursodeoxycholic acid preparations (Ursofalk) can be recommended for the prevention of cholelithiasis. Considering the role of intestinal microflora in the pathogenesis of NAFLD, it is necessary to correct dysbiotic changes as well as basic pharmacotherapy. Thus, a comprehensive approach to the management of patients with NAFLD and T2DM should be aimed not only at therapy, but also at the prevention of associated metabolic disorders.

Terapevticheskii arkhiv. 2022;94(10):1155-1162
pages 1155-1162 views

Efficacy of Saccharomyces boulardii CNCM I-745 probiotic drug in the prevention and treatment of diarrhea in hospitalized patients with new coronavirus infection COVID-19

Maev I.V., Andreev D.N., Sokolov P.S., Fomenko A.К., Devkota M.K., Andreev N.G., Zaborovsky A.V.


Aim. To evaluate the efficacy of Saccharomyces boulardii (S. boulardii) CNCM I-745 probiotic drug in preventing and treating diarrhea in hospitalized patients with COVID-19.

Materials and methods. A prospective comparative study was conducted in two parallel groups. The study included males and females aged 18 to 60 with the following diagnosis confirmed by polymerase chain reaction: U07.2 Coronavirus infection COVID-19, caused by SARS-CoV-2 virus (grade 1–3 pneumonia according to CT scan). All patients received antibiotic therapy. The patients were subdivided into two equal groups (n=60) depending on the administration of S. boulardii CNCM I-745 probiotic drug in addition to standard treatment. The probiotic was prescribed by the attending physician; the dose was 2 capsules per day (500 mg/day) 30 min before the meal for 10 days. All patients were monitored for main clinical, laboratory, and instrumental parameters during the study. In addition, the symptom of diarrhea (stool with a frequency of more than 3 times a day of type 6 and 7 according to the Bristol stool scale), including its frequency, duration, and the number of bowel movements of loose stool per day were precisely evaluated in both groups.

Results. In the overall patient pool, diarrhea was reported in 21.7% of in-patients during the observation period (95% confidence interval [CI] 14.2–29.1) with a mean duration of 4.6154 days (95% CI 3.7910-5.4398). The incidence of diarrhea in group 1 was 13.3% (95% CI 4.5–22.2), and in group 2, it was 30.0% (95% CI 18.1–41.9). Relative risk showed that the use of the S. boulardii CNCM I-745 probiotic drug leads to a significant reduction in the risk of diarrhea in hospitalized patients with COVID-19 infection receiving antibiotic therapy (odds ratio [OR] 0.3590, 95% CI 0.1421–0.9069; p=0.0303). In group 1, the duration of diarrhea was 3.1250 days (95% CI 2.5892–3.6608) versus 5.2778 days (95% CI 4.2290–6.3265) in group 2, p=0.0112. The mean daily frequency of loose stools in patients with diarrhea in group 1 was 3.2500 (95% CI 2.6588–3.8412) versus 4.3889 (95% CI 3.7252–5.0525) in group 2, p=0.0272. The secondary endpoint, duration of hospital stay, was also significantly shorter in group 1 patients — 11.6833 days (95% CI 11.2042–12.1625) versus 12.7333 days (95% CI 12.1357–13.3309) in group 2, p=0.0120.

Conclusion. The present prospective comparative study demonstrated that adding S. boulardii CNCM I-745 probiotic drug into the standard treatment regimen of patients with new coronavirus infection COVID-19 receiving antibiotic therapy helps reduce the incidence of diarrhea and its severity during hospitalization, as well as the duration of hospital stay.

Terapevticheskii arkhiv. 2022;94(10):1163-1170
pages 1163-1170 views

Prospects of using the nucleoside analogue riamilovir in patients with SARS-CoV-2 infection

Maltsev O.V., Kasyanenko K.V., Kozlov K.V., Zhdanov K.V., Lapikov I.I.


Aim. To evaluate clinical efficacy of nucleoside analogues in therapy of moderate COVID-19 in in-patients.

Materials and methods. Retrospective processing of 108 completed clinical cases with moderate novel coronavirus disease was carried out for the period 2020–2021. The duration of the disease at the time of admission did not exceed three days. Experimental group consisted of 53 patients who, in addition to standard therapy, were prescribed “off-label” riamilovir at a daily dosage of 1250 mg for 5 days by the decision of the medical commission. Comparison group included 55 patients who received a combination of umifenovir and ribavirin as antiviral therapy for 5 days. The duration of the main clinical manifestations of the disease, the indicators of clinical and biochemical blood tests, results of the SARS-CoV-2 virus RNA study using the nucleic acid amplification method (NAAT diagnostics).

Results. Significantly faster achievement of clinical improvement in the group of patients treated with riamilovir was shown, as well as faster sanitation from SARS-CoV-2 virus based on the results of etiological testing.

Conclusion. The use of riamilovir for the treatment of patients with moderate novel coronavirus infection (COVID-19) resulted in a significant reduction of general infectious syndromes and respiratory symptoms. Patients from the experimental group significantly faster achieved clinical recovery and sanitation from the pathogen according to the results of NAAT diagnostics.

Terapevticheskii arkhiv. 2022;94(10):1171-1176
pages 1171-1176 views

Clinical notes

Management of a patient with diabetes mellitus after total pancreatectomy. Case report

Ametov A.S., Shabunin A.V., Pashkova E.Y., Amikishieva K.A., Golodnikov I.I., Tavobilov M.M., Vlasenko A.V., Lukin A.Y.


In modern diabetology, the most important condition for a personalized approach to patient management is to determine the type of diabetes mellitus. Particular attention is drawn to a large, but at the same time insufficiently studied group of patients with diabetes mellitus due to diseases of the pancreas or as a result of surgical interventions on the pancreas, in particular, patients who, for a number of vital indications, undergo total pancreatectomy and the mechanism of development of impaired glucose homeostasis have not been studied in these patients. To date, there are no specific algorithms for managing this category of patients. This clinical example emphasizes that the management of glycemia in patients with diabetes mellitus as a result of total pancreatectomy is an extremely difficult task that requires a multidisciplinary approach in the treatment of this category of patients, the participation of an endocrinologist at all stages of patient treatment.

Terapevticheskii arkhiv. 2022;94(10):1177-1181
pages 1177-1181 views


Intermittent fasting: endocrine aspects: A review

Altashina M.V., Ivannikova E.V., Troshina E.A.


The increasing number of overweight and obese people makes the search for new effective ways to reduce body weight extremely urgent. Recently, intermittent fasting has received a lot of attention, as a dietary protocol, presumably effective in reducing body weight. Despite the large number of studies, the effects of intermittent fasting on the human body are controversial, since studies differ in dietary options, design, and often have a small sample size. In this review of the literature, the authors cite the results of studies of the effectiveness of intermittent fasting in patients with obesity, diabetes mellitus, and high risks of developing cardiovascular diseases.

Terapevticheskii arkhiv. 2022;94(10):1182-1187
pages 1182-1187 views

Sub-analyses of the DAPA-CKD study: new data on the use of sodium-glucose cotransporter type 2 inhibitor in the treatment of chronic kidney disease

Shamkhalova M.S., Sukhareva O.Y., Shestakova M.V.


Sodium-glucose cotransporter inhibitors updated their position in the therapy of patients with type 2 diabetes mellitus due to proven nephro- and cardioprotective effects. The DAPA-CKD study, performed among individuals with CKD of various etiologies, was also conducted in a mixed population, including patients without type 2 diabetes, showed the ability of dapagliflozin to reduce the risk of the primary combined endpoint (eGFR<15 ml/min/1.73 m2, the need for chronic dialysis or kidney transplantation, time to renal or cardiovascular death), and certain secondary endpoints. Due to the inclusion of dapagliflozin into the treatment of the patients with CKD of not only the diabetic origin and the expected subsequent significant expansion of the patient population with indications for the use of this drug, the review of the results of the sub-analyses of DAPA-CKD study may be of interest to the clinicians.

Terapevticheskii arkhiv. 2022;94(10):1188-1196
pages 1188-1196 views

Social and psychological risk factors for decreased adherence among patients with atrial fibrillation

Troshina D.V., Andreev D.A., Fomicheva A.V., Volovchenko A.N., Volel B.A.


Adherence has a direct impact on reducing the effectiveness of atrial fibrillation therapy and increasing the risk of thromboembolic events. Among the factors involved in the decrease of adherence, the social and psychological characteristics of patients remain insufficiently studied. At the same time, the available publications allow us to conclude that there are markers of the risk of reduced adherence in patients with atrial fibrillation, which include age, cognitive impairment, psychoemotional disorders (including depression and anxiety) and specific behavioral patterns.

Terapevticheskii arkhiv. 2022;94(10):1197-1203
pages 1197-1203 views

New opportunities of antithrombotic therapy in patients with type 2 diabetes mellitus and stable coronary heart disease for reducing the cardiovascular risk and cardiovascular complications: THEMIS, THEMIS-PCI trials

Kalashnikov V.I., Michurova M.S.


Patients with diabetes mellitus (DM) and coronary heart disease belong to a group with a very high risk of developing cardiovascular disease. In patients with coronary atherosclerosis, DM increases the risk of ischemic events by 2–4 times. Apparently, increased antithrombotic therapy has an advantage in patients with DM who have had myocardial infarction. However, until recently it was not clear there is such an advantage in patients with DM and stable coronary artery disease without prior myocardial infarction. The addition of ticagrelol to monotherapy of acetylsalicylic acid reduces the risk of major cardiovascular events in patients with type 2 DM and stable coronary artery disease undergoing percutaneous coronary intervention, if patients have a high risk of ischemic events.

Terapevticheskii arkhiv. 2022;94(10):1204-1210
pages 1204-1210 views

History of medicine

Radioactive iodine in the treatment of Graves' disease: history and modern concept of radionuclide therapy

Sheremeta M.S., Korchagina M.O., Pesheva E.D., Fadeev V.V.


Radioactive iodine 131I is a theranostic isotope used both for diagnosis and therapy of benign thyroid diseases and thyroid cancer for 85 years. The formation of nuclear medicine is closely linked with the use of 131I. The history of radioiodine therapy began in 1941, when endocrinologist Saul Hertz for the first time used 131I to treat patients with Graves' disease. Since 1946 radioactive iodine 131I became widely available, and its effectiveness became public knowledge after reports on thyrotoxicosis treatment published in the Journal of the American Medical Association by multidisciplinary groups of scientists – physicists and endocrinologists. In 1951, isotope 131I became the first Food and Drug Administration approved RP for the treatment of thyroid disorders. Around the same time on the basis of the First Moscow Medical Institute studies on the use of radioiodine isotopes in patients with thyrotoxicosis began. The head of the Soviet group on the studying of radioactive iodine was the physician-scientist Vera Georgievna Spesivtseva. The research works of medical physicists Edith Quimby and Leonidas Marinelli in optimizing therapeutic strategies using radioactive substances in the late 1940s and the wording of the ALARA (As Low As Reasonably Achievable) principle of minimizing exposure of ionizing radiation by the International Commission on Radiological Protection in 1954 contributed to the greater introduction of radionuclides into the medicine.

Terapevticheskii arkhiv. 2022;94(10):1211-1215
pages 1211-1215 views

Historical aspects of diagnosis and control of diabetes mellitus

Kuzina I.A., Goncharova E.V., Martirosian N.S., Telnova M.E., Nedosugova L.V., Tulsky A.A., Petunina N.A.


Diabetes mellitus is a group of metabolic diseases affecting carbohydrate, lipid, and protein metabolism. This pathology has a long history, and it was considered a disease of the kidneys until the middle of the 19th century. Descriptions have been found in Egyptian papyri, in ancient Indian and Chinese medical literature, in the writings of ancient Greek and Arab doctors. Aretaeus of Cappadocia gave the first accurate description of the disease, coining the term “diabetes”. Thomas Willis first differentiated diabetes from other causes of polyuria by the sweet taste of urine. Matthew Dobson proved the presence of glucose in urine by evaporation. Claude Bernard demonstrated that hyperglycemia contributes to glucosuria. This is how the concept of the renal threshold appeared. In domestic practice, the term "renal threshold" was introduced by endocrinologist V.G. Baranov. The development of qualitative tests for determining glucose in the urine, the creation of test strips and glucometers has significantly improved the quality of life of patients with diabetes. The current stage of development of glucometry includes the determination of fasting plasma glucose, postprandial glycemia, glycated hemoglobin, as well as continuous glucose monitoring. Continuous glucose monitoring systems make it possible to estimate the time in target range, show the rate of rise or fall of glucose levels. It affects the rate and degree of carbohydrate metabolism compensation and allows for maximum control of the disease.

Terapevticheskii arkhiv. 2022;94(10):1216-1220
pages 1216-1220 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies