A new approach to the treatment of the Type 2 diabetes mellitus (T2DM) based on drug-induced glycosuria and reduction in renal threshold of glucose, and drugs with a similar mechanism of action belong to an innovative class of antidiabetic drugs: inhibitors of 2nd type sodium-glucose cotransporter (GLT-2). In addition to improving glycemic control SGCT-2 inhibitors promote moderate weight loss and blood pressure (BP), increased sensitivity of tissues to insulin and improve β-cell function. Dapagliflozin an oral SGCT-2 inhibitor, which is due to the insulin independent mechanism of action is characterized by the minimal risk of hypoglycemia compared to traditional antidiabetic drugs, such as sulfonylurea and insulin. For this reason, the drug has the unique ability to combine with other oral hypoglycemic agents (OHGA). In addition, due to its natriuretic effect and ability to reduce body weight and blood pressure dapagliflozin is the drug of choice in patients with T2DM and cardiovascular diseases of atherosclerotic genesis. A combination of advantages, including a favorable safety profile of dapagliflozin allows extensive use of this drug for the initiation and intensification of T2DM treatment.

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The article discusses the potential opportunities for impact of antidiabetic drugs from the group of glucagon-like peptide-1 (GLP- 1) receptor agonists on the risks of development and progression of cardiovascular complications in patients with type 2 diabetes mellitus (T2DM) and their possible role in increasing the patients’ expectancy and quality of life. The existing differences between the drugs of this class should be taken into account in using personalized approach to therapy, developing and introducing new guidelines for specialized medical care for patients with type 2 diabetes into clinical practice. The article presented data on the efficacy and safety of the use of GLP-1 receptor agonists and discusses data on the possible mechanisms of non-glycemic effects underlying their cardio and nephroprotection. The features of pharmacological characteristics affecting the clinical efficacy and development of side effects are considered. The article also provides data from randomized clinical trials of various GLP-1 receptor agonists that demonstrate the positive effect of drugs of this class on cardiovascular and nephrological outcomes in patients with type 2 diabetes.

A rare case of severe asphyxia in a young patient due to household gas leakage WAS presented. The patient was found in an unconscious state with signs of respiratory failure at home, requiring respiratory support at the prehospital stage. The patient had a picture of damage to the circulatory organs with the development of acute myocardial ischemia without damage and reactive hydropericardium, respiratory organs in the form of hypoxic pulmonary edema, complicated by the development of bilateral community-acquired pneumonia, hydrothorax and severe respiratory failure, damage to the nervous system with the development of hypoxic encephalopathy with loss of consciousness and bilateral pyramidal syndrome, digestive organs with the development of reactive posthypoxic hepatopathy. Upon admission to the clinic of the field therapy of the Military Medical Academy of S.M. Kirov, which required hospitalization of the patient in the intensive care unit. It was possible to fully stop severe multiple organ damage that developed as a result of acute hypoxic exposure as a result of the complex treatment. This clinical case clearly demonstrates the importance of emergency, systematic and full-fledged intensive care at all stages of providing care to people with acute hypoxic lesions of organs and systems, including severe community-acquired pneumonia and hypoxic myocardial dystrophy. The influence of the early intensive care initiation and timely evacuation at the stage of qualified and specialized medical care on the effectiveness of therapeutic measures is discussed as this plays a fundamental role in the survival of this category of patients. In general, with timely and full-fledged therapeutic measure implementation aimed at treating complications, even severe acute hypoxic organs lesions and systems are reversible, although this may require long-term inpatient treatment and rehabilitation measures in a military sanatorium-resort organization condition of a therapeutic profile, as well as conducting a military medical examination to establish the fitness category for further military service.

Objective of the Review: To present mechanisms of system and cardioprotective action of glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists); to describe their efficiency and role in primary prevention of cardiovascular complications in patients with type 2 diabetes mellitus (DM2) following large randomised clinical cardiovascular safety trials from PubMed, Cochrane Library, Google Scholar. Key Points. Clinical trials showed that GLP-1 receptor agonists can have marked positive effect for glycated haemoglobin and low-density lipoprotein cholesterol levels, systolic blood pressure, body weight, and some drugs from this group can significantly reduce the rate of primary composite cardiac end point 3P-MACE, irrespective of history of cardiovascular diseases. Conclusion. GLP-1 receptor agonists exhibit proven advantages for cardiovascular outcomes. Therefore, they are drugs of choice in therapies of DM2 patients. GLP-1 receptor agonists can increase the efficiency of not only secondary, but also primary prevention of cardiovascular complications. Keywords: diabetes mellitus, glucagon-like peptide-1 receptor agonists, cardiovascular complications, primary and secondary prevention.