Cardiovascular diseases are a frequent comorbid condition in patients with type 2 diabetes mellitus (t2DM). This problem tends to remain acute because of the progression of t2DM, which increases the chances of cardiovascular events. Medicine today has a range of innovative hypoglycemic drugs, which proved their safety and effectiveness towards diseases of cardiovascular system. However, high cardiovascular mortality demonstrates that the medication is not enough effective. Partly lack of success may be explained by not enough work with unmodified risk factors, such as physical activity, smoking and excessive and wrong nutrition. Studies about dietary fiber (DF) let us discuss their including in the dietary plan of patients with t2DM and cardiovascular diseases. One of the promising DF types is Cyamopsis tetragonoloba extract. It showed its effectiveness concerning carbohydrate metabolism and lipid profile, improving, metabolic features of t2DM patients and lowering the risks of cardiovascular events. What is more, the advantage of Cyamopsis tetragonoloba extract is easy to use and has no side effects.

Журнал для непрерывного медицинского образования врачей алоглиптин и пиоглитазон. Перспективы комбинированного примененияФедеральное государственное автономное образовательное учреждение высшего образования «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Министерства здравоохранения Российской Федерации, 117997, г. Москва, Российская Федерация

The number of new cases of diabetes mellitus (DM) and its complications is rapidly increasing and a great amount of cases remains undiagnosed. It demonstrates that improvement of existing methods of treatment can be extremely helpful in present situation. It is known, that one of components of pathogenesis of DM is gut microbiota (GM) and its metabolism. Metabolites of GM include short-chain fatty acids (SCFA), some gases, energy and some low molecular metabolites. From the point of influence on stage of diabetes mellitus SCFA are the most interest. They are not only the main source of energy for colonocytes with antiischemic and protective properties, concerning the gut wall, but they also increase satiety, reduce insulin resistance, improve β-cell function and lead to decrease in body mass. Functions of SCFA are so versatile that they can be mentioned in DM with relative and absolute insulin deficiency as well. Due to its plasticity, GM can change its structure and functions in response to some changes in organism. However, in people with DM these changes are severe and continuous, which makes total amount of microorganisms and their proportion change irreversibly, leading to associated changes in amount of SCFA. Considering the positive effects of SCFA on carbohydrate metabolism, modulation of GM metabolism may occur an efficient addition to antidiabetic therapy. One of the powerful factors, influencing GM, is dietary fiber (DF). They are an energetic substrate for GM, they also maintain pH necessary for GM and regulate food passage in gastrointestinal system. Studying the influence of SCFA on DM and correction of metabolic dysregulation with DF need special attention, as DF and SCFA may become a powerful addition to antidiabetic therapy.

The management of diabetes in the elderly requires careful consideration of concomitant geriatric syndromes and chronic diseases that increase the risk of complications, including severe hypoglycemia. An individualized approach to the treatment of elderly patients includes the establishment of less strict goals of glycemic control, blood pressure control, taking into account impaired self-care abilities, cognitive abilities and loss of vision. The goals of diabetes treatment in the elderly are considered to maintain the quality of life and minimize symptomatic hyperglycemia, the risk of hypoglycemia and side effects of medications. In this regard, the concept of deprescribing in the treatment of elderly patients is gaining more and more popularity.

Insulin resistance (IR) is an important problem of humanity, which leads to development of many metabolic disorders. Сurrently the pathogenic mechanism of the development of IR is not completely investigated. Nevertheless, there are some hypotheses explaining the development of this condition. These include such hypotheses as the hypothesis of thrifty genotype, thrifty phenotype, hormonal, stress, good and bad calories, chronic metabolic inflammation, microbiotic and integrated model suggested by Professor Rainer Straub. In this article, the microbiotic theory will be considered in detail, explaining the mechanism of the development of peripheral tissue insensitivity to insulin in dysbiosis due to amplification of transmission by proinflammatory molecules from the intestine to the bloodstream and activation of systemic inflammation, disruption of the “gut-brain-periphery” mechanism and impaired receptor interactions of active intestinal metabolites of the gut microbiota (GM) at the level of cells of metabolic organs. The value of this theory is that its factors affect all links in the pathogenesis of the development of IR, reflected in the integrated model of Professor Straub. In this review the influence of GM and metabolic processes of human body on the development of IR will be considered in detail, data from clinical studies about the influence of GM (its composition, active metabolites, individual bacterial strains) on the development of IR and the role of chronic metabolic inflammation in this process will also be presented. In addition, attention will be paid to bidirectional effects of GM and metformin, as well as to data from clinical studies on changes in GM in healthy people and people with IR under the influence of metformin and how GM affects the pharmacokinetics of this drug. The possibility of IR correction through the use of dietary fiber will also be considered.