The article is a summary of personal experience and lite­rature data from PubMed, Scopus, Web of Science, ClinicalTrials.gov databases. As a result of the analysis, the main problems faced by practical endocrinologists when administering insulin therapy to patients with type 2 diabetes mellitus (T2DM) have been determined. Insulin therapy remains an important component of glucose-lowe­ring therapy in T2DM. A significant increase in the number of oral hypoglycemic agents has allowed delaying the start of insulin therapy but the treatment for T2DM without insulin is not real today. The current problems of insulin therapy are as follows: untimely start, insufficient titration of the dose of basal insulin, excessive use of basal and bolus insulins, the irrationality of the use of premixes and the basis bolus regimen of insulin therapy. There are methods to overcome each of these issues that have proven their effectiveness according to clinical trials and real clinical practice data. The combination of insulin and oral therapy plays an important role, the addition of oral hypoglycemic agents is effective at different stages of insulin therapy. One of the most promising options is the use of fixed combinations of basal insulin with glucagon-like peptide-1 receptor agonists. Fixed combinations can be used as initial therapy and are often the first step when changing other insulin therapy regimens. The use of fixed combinations can be an option for modification (simplification) of complex insulin therapy regimens, including the basal bolus regimen. Authors review current evidence and circumstances in which insulin can be used, consider individualized choices of alternatives and combination regimens, and offer some guidance on personalized targets and approaches to glycemic control in type 2 diabetes. In general, most of the modern problems of insulin therapy have options for successful overcome.

The article is a review of the literature in Scopus, Web of Science, MedLine and The Cochrane Library and is devoted to the analysis of the evidence base of the use of selenium supplements for the treatment of thyroid pathology. Despite the variety of thyroid pathology: changes in size and structure, hypo- and hyperfunction, autoimmune, oncopathology, there are not so many drugs used in its medical treatment. Drugs that are justified for various thyroid pathologies include iodine, levothyroxine and, to some extent, triiodothyronine, thyrostatics (methimazole, carbimazole, propylthiouracil), radioactive iodine and glucocorticoids, such as beta-blockers. Acute thyroiditis requires the appointment of antibacterial therapy, and oncopathology — specific chemotherapeutic agents, the effectiveness of which, unfortunately, is not high, and the frequency of appointment is significant. Along with these drugs, selenium drugs have become unprecedented in the last decade in thyroid pathology as a component of possible pathogenetic therapy. These drugs are prescribed to patients with diametrically opposed functional state of the thyroid gland, autoimmune patho­logy, nodules. It appears that thyroid carcinogenesis remains the only pathology where the use of selenium drugs is not recommen­ded, although there are studies that indicate a link between thyroid cancer and selenium deficiency. The results of clinical studies and meta-analyzes are provided through the prism of a survey of Italian and European endocrinologists on the appointment of selenium drugs for the treatment of relevant thyroid pathology. The lack of evidence base for the use of selenium in most types of pathology of the thyroid gland: autoimmune thyroiditis, overt and subclini­cal hypothyroidism, Graves’ disease. According to most studies, the supplementation of selenium to therapy increases its plasma level, affects the activity of selenoproteins and level of antithyroid antibodies, but in no way affects the main clinical parameters such as thyroid hormones, levothyroxine dose, clinical symptoms. In ge­neral, the use of selenium in thyroid pathology cannot be considered appropriate, except for a mild form of Graves’ orbitopathy. Signi­ficant differences in the data of clinical trials and recommendations of thyroid societies with a real frequency of selenium administration by practitioner for the treatment and prevention of thyroid pathology are indicated.