Vol 32, No 8 (2025)

Objective: Evaluation of the evidence on the efficacy of psyllium as a metabolic corrector in obesity and type 2 diabetes mellitus (DM2): effects on glycemia (plasma glucose, HbA1c), insulin resistance, anthropometric parameters (body weight, body mass index, waist circumference), lipid metabolism parameters, safety, and tolerability.

Materials and methods: Narrative, non-systematic review using the following sources: PubMed/MEDLINE, PMC, ScienceDirect (Elsevier), ClinicalTrials.gov. Search terms included «psyllium,» «Plantago ovata,» «psyllium husk,» «diabetes,» «type 2 diabetes,» «obesity,» «weight,» «lipids,» «metabolic syndrome,» «randomized,» and «systematic review.» The search covered publications up to October 2025. Randomized controlled trials (RCTs), meta-analyses, and large scientific reviews relevant to the topic were included. Inclusion criteria: studies in adult patients with obesity and/or DM2, lasting at least 4 weeks, and reporting at least one metabolic outcome (glucose, HbA1c, lipids, body weight). Experimental animal studies (except those with useful mechanistic data) were excluded.

Results: Psyllium is a dietary supplement that influences nutrient absorption. Psyllium demonstrated a clinically significant reduction in postprandial glycemia, a moderate decrease in HbA1c (by an average of 0.3–0.6%), and a reduction in low-density lipoprotein and total cholesterol. The effect on body weight and triglycerides was less clear. Psyllium was well tolerated, with side effects observed primarily involving the gastrointestinal tract (flatulence, bloating).

Conclusion: Psyllium may be a useful adjunct therapy in overweight patients at risk for DM2, with DM2, and dyslipidemia. Larger, longer-term RCTs are required to confirm its independent role in obesity correction and long-term metabolic control.

The number of patients with type 2 diabetes mellitus (DM2) and comorbid conditions is steadily increasing worldwide. For patients with DM2, achieving target carbohydrate metabolism parameters is important, as is weight loss, improving blood lipid profiles and blood pressure, and optimizing the course of comorbid conditions. The most commonly discussed comorbid conditions are lower extremity peripheral arterial disease (LEPAD), cardiovascular disease (CVD), metabolic-associated fatty liver disease (MAFLD), and diabetic kidney disease (DKD). Improved carbohydrate metabolism, weight loss, and reduced progression of cardiovascular disease, LEAD, MAFLD, and DKD can be achieved with semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 agonist). Semaglutide has demonstrated high efficacy in correcting glycemic and lipid profiles, as well as reducing body weight and blood pressure. Multicenter clinical trials have demonstrated its pronounced cardio-nephro-hepatoprotective effects, as well as a significant reduction in the risk of developing and progressing micro- and macrovascular complications.

Objective: Evaluation of the efficacy of semaglutide (Queensenta^®) in real-world clinical practice in patients with type 2 diabetes mellitus (DM2).

Materials and methods: Thirty DM2 patients aged 40 to 65 years were examined. The study parameters were recorded at baseline and over time after 3 and 6 months while starting semaglutide therapy at a dose of 1 mg subcutaneously once a week. The analysis assessed changes in carbohydrate metabolism parameters, anthropometric parameters, changes in the blood lipid profile, liver and kidney function parameters, and the development of hypoglycemic states.

Results: By the end of the follow-up period, improvements in all carbohydrate metabolism parameters were noted: glycated hemoglobin levels decreased from 7.49±0.41 to 6.09±0.59% (p<0.05), and fasting glucose decreased from 8.63±1.18 to 6.58±1.08 mmol/L (p<0.05). Changes in anthropometric parameters were also noted. After 24 weeks of treatment, the mean body weight loss in the study cohort was 8.6 kg (-8.5% from baseline; p<0.05), body mass index -3.1 kg/m² (-8.6%; p<0.05). There was also a decrease in waist circumference by 10.1 cm and hip circumference by 6.6 cm (both p<0.05), as well as a decrease in fat mass (-5.4 kg; p<0.05). The decrease in triglyceride levels was -0.18±0.75 mmol/L, equivalent to -8.6%, but the changes did not reach statistical significance (p=0.22). Systolic blood pressure (SBP) decreased from 138.4±12.8 to 127.2±18.4 mmHg. The absolute decrease by week 24 was -11.8±16.0 mmHg (p<0.05). A decrease in diastolic blood pressure (DBP) by week 24 was noted by -5.6±9.6 mmHg (p<0.05). There was a tendency towards a decrease in the level of liver enzymes (ALT from 34.8±21.48 to 26.1±12.57 U/L, AST from 28.1±14.12 to 20.8±6.73 U/L over 24 weeks). An improvement in the quality of life was noted, which was assessed using the standardized EQ-5D-3L questionnaire, including the main domains of physical and psychoemotional state, as well as a visual analog scale (VAS), reflecting the patient’s subjective general health assessment. The total EQ-5D-3L score was 0.90±0.09 at baseline. After 24 weeks, the increase was +0.04 (p<0.05). The VAS score was 71.2±11.3 at baseline, and +7.0±10.2 at 24 weeks (p<0.05). Most patients reported improved well-being, decreased limitations in daily activities, and increased satisfaction with their current health. Side effects, such as transient dyspeptic symptoms, were reported in 36.7% of patients and did not require discontinuation of the drug. No hypoglycemic episodes were reported.

Conclusion: For the first time in Russia, a comprehensive study to evaluate the effect of intensified semaglutide (Quincenta^®) therapy on carbohydrate metabolism parameters, anthropometric parameters, blood lipid profiles, and liver and kidney function in patients who had not achieved treatment targets on metformin monotherapy was conducted. The safety of the studied therapy was also assessed. The results of the study confirm the high efficacy and safety of Quincenta^® in routine use in patients with type 2 diabetes mellitus.

Background: In recent years, nutrition and the role of essential microelements (EM) in the development of neoplastic processes have received increasing attention. While there is compelling evidence on the role of individual EM and complex deficiencies in EM status in the development of nodular goiter, there is insufficient data on the role of EM in the development of thyroid tumors, particularly benign follicular thyroid adenoma (FA). This was the reason for conducting this study.

Objective: Evaluation of hair levels of selenium (Se), zinc (Zn), and copper (Cu) and the relationships between these elements in individuals with FTA.

Materials and methods: An observational, open-label, cross-sectional, single-center study was conducted, including 107 women diagnosed with FTA aged 20–60 years. The control group (n=46) consisted of women aged 20–60 years without severe somatic pathology or thyroid disease. All patients underwent anthropometric assessment (height, weight, BMI, waist circumference (WC), waist-to-hip ratio (WHR), blood tests for thyroid hormones, thyroid ultrasound, and atomic absorption spectrophotometry for hair levels of Se, Zn, and Cu.

Results: Individuals with thyroid FA were significantly more likely to have deficiencies in Se, Zn, and Cu in their hair. Se deficiency was detected in 70.1%, Zn deficiency in 65.4%, and Cu deficiency in 64.5% of women with FTA. Moreover, the levels of these EMs were lower than in the control group. The median Se level in individuals with FTA was 0.13 (0.09; 0.15) μg/g, in the control group – 0.165 (0.15; 0.28) μg/g (p=0.000), Zn – 175 (169; 180) μg/g, in the control group – 184.5 (181; 189) μg/g (p=0.000), Cu – 10.8 (9.8; 11.2) μg/g, in the control group – 11.5 (11; 11.9) μg/g (p=0.000). An imbalance of the microenvironment, expressed as a lower Se/Zn and Se/Cu ratio in the hair of individuals with FTA, was detected, as well as direct correlations between Se and Zn, and Zn and Cu in the hair of individuals with FTA.

Conclusion: The obtained results suggest that an imbalance of the microenvironment may influence the development of FTA.

Objective: Evaluation of the efficacy and safety of glucagon-like peptide type 1 receptor agonists (GLP-1 RA) in combination with symptomatic slow acting drugs for osteoarthritis (SYSADOA) in patients with knee osteoarthritis (OA) and obesity and type 2 diabetes mellitus (DM2).

Materials and methods: The pilot phase of the randomized study included 117 patients aged 35 to 65 years with Kellgren-Lawrence stages I–III knee osteoarthritis (OA) and a body mass index (BMI) ≥30 kg/m² (74.4% were women). Group 1 included patients with knee osteoarthritis and obesity without DM2. Groups 2, 3, and 4 included patients with gonarthrosis, obesity, and DM2. Participants were randomly assigned to four groups matched for age, gender, BMI, and radiographic stage of knee OA: patients in group 1 (n=29) received diacerein therapy, patients in group 2 (n=29) received diacerein in combination with metformin, patients in group 3 (n=29) received diacerein in combination with semaglutide (SEMA), and patients in group 4 (n=30) received diacerein and semaglutide with subsequent dose escalation. Patients in Groups 3 and 4 treated with semaglutide underwent a standard stepwise titration: 0.25 mg once weekly for the first 4 weeks, then 0.5 mg once weekly for the next 4 weeks, and 1.0 mg once weekly for the final 4 weeks of follow-up. By week 12, all patients receiving semaglutide were receiving 1.0 mg once weekly. Higher doses of semaglutide were not used in this phase of the study. The follow-up period duration was 12 weeks. The primary endpoints were relative change in body weight and changes in the WOMAC pain subscale. Pain intensity was also assessed using a visual analog scale (VAS, 0–100 mm); C-reactive protein (CRP) levels, and adverse events (AEs) were also recorded.

Results: At baseline, the mean body weight of patients was 99.3±8.3 kg, the mean WOMAC pain subscale score was 11.0±3.4, pain intensity according to VAS was 60±17 mm, and the CRP level was 6.4±3.1 mg/l. After 12 weeks, the body weight of patients in group 1 remained virtually unchanged and was +0.2% compared to the baseline value. Patients in group 2 showed a moderate weight loss (-1.6%). In patients in groups 3 and 4, the weight loss was more pronounced and was 4.0% of the baseline level (-4.0% in group 3 and -4.1% in group 4). In patients in group 1, the pain reduction according to the WOMAC pain subscale was 10.9%, and in patients in group 2 - 12.7%. In patients of groups 3 and 4, pain reduction according to this subscale reached 26.4 and 27.3%, respectively. When assessing pain according to the VAS, pain intensity reduction in patients of groups 1 and 2 was 6.8 and 8.3%, while in patients of groups 3 and 4 it - 15.2 and 18.3%. The CRP level in patients of groups 1 and 2 remained virtually unchanged during the follow-up period (a decrease of 2.8 and 3.9%, respectively). Patients of groups 3 and 4 showed a more pronounced decrease in CRP by 13.6 and 14.9% compared to baseline values. Thus, patients who were prescribed diacerein in combination with semaglutide (groups 3 and 4) experienced a more significant decrease in body weight, pain severity, and CRP level compared to patients of groups 1 and 2 who received regimens without semaglutide, while maintaining an acceptable safety profile. Adverse events (AEs) were reported in 19 patients (16%), and only 2 (1.7%) led to treatment discontinuation.

Conclusion: In patients with knee OA, obesity, and DM2, the addition of semaglutide (Velgia) to diacerein for 12 weeks resulted in clinically significant weight loss, reduced pain scores (WOMAC and VAS), and decreased CRP levels compared to the semaglutide-free groups, with an acceptable safety profile. These data support the need for further, longer-term randomized trials, including those evaluating the efficacy and safety of higher semaglutide doses (Velgia 1.7 mg; 2.4 mg).

Background: Prevention of thromboembolic complications is a pressing issue in pharmacology. Its importance in orthopedics is driven by the increasing number of joint arthroplasties performed year after year. Existing thromboprophylaxis regimens and recommendations take into account many risk factors. However, a number of diseases and conditions whose role in the development of thromboembolic complications has not been fully elucidated. This study demonstrates the influence of hyperhomocysteinemia in osteoporosis on the incidence of these complications after total knee arthroplasty. The clinical and pathogenetic aspects of thrombosis development in this patient group are presented. Risk stratification for these complications is substantiated, with recommendations for prolonged pharmacoprophylaxis in patients with osteoporosis and hyperhomocysteinemia.

Objective: Evaluation of the influence of bone density on the development of venous thromboembolic complications after total knee arthroplasty (TKA).

Materials and methods: Eighty patients after total knee arthroplasty were examined. D-dimer levels were determined pre- and postoperatively using an immunoturbidimetric method. Plasma homocysteine levels were also measured using an enzymatic method. Bone mineral density was assessed using densitometry of the proximal femurs and lumbar spine. The results were evaluated using the T-score. Microsoft Excel 2016 and Statistica 10.0 were used for data processing.

Results: The study found that hyperhomocysteinemia occurred exclusively in the group of patients with osteoporosis. In patients with normal bone density and osteopenia, homocysteine concentrations did not exceed the reference range. Osteoporosis in patients is accompanied by higher mean preoperative homocysteine levels compared to patients with normal bone density and osteopenia. Women with osteoporosis and elevated homocysteine levels are at higher risk of thromboembolic complications after total knee arthroplasty. Group II patients with preoperative hyperhomocysteinemia who experienced thromboembolic complications after arthroplasty have a more pronounced increase in D-dimer levels on day 7 postoperatively. This may serve as a basis for revising existing thromboprophylaxis regimens quantitatively, with a view to prolonging the duration of anticoagulant treatment and qualitatively increasing the use of non-pharmacological thromboprophylaxis methods in patients of this group. Given the statistically significant higher incidence of VTEC after TKA, more careful patient selection for surgical treatment is necessary, with recommendations for treating this condition until the quantitative BMD indicator (T-score) improves to ≥-2.5 SD. This study found that hyperhomocysteinemia is not only an important predictor of osteoporosis and a risk factor for thrombosis, but also increases the incidence of VTEC after TKA in patients with osteoporosis. This phenomenon reflects the unfavorable course of osteoporosis associated with hyperhomocysteinemia and confirms several studies on the role of hyperhomocysteinemia in the pathogenesis of osteoporosis and thrombosis.

Conclusion. Given the obtained study results, further study of the impact of osteoporosis on the risk of VTEC after orthopedic surgeries other than TKA is necessary, including for the purpose of pharmacological correction of this pathology and identifying opportunities to supplement existing pharmacoprophylaxis regimens for this group of complications.

Background: The timely and rational use of innovative groups of hypoglycemic agents, including as part of combination therapy, facilitates individualization of therapy and enables significant advances in diabetes treatment. Despite the diversity of hypoglycemic agent classes for the treatment of type 2 diabetes mellitus (DM2), the issue of initiating and intensifying insulin therapy remains relevant and in demand. Basal insulin is the most feasible option for planned intensification of hypoglycemic therapy when other optimal treatment regimens are ineffective or intolerant, with a moderate increase in target glycemic control.

Description of the clinical case: This clinical case demonstrates approaches to individualizing the choice of basal insulin in combination with oral hypoglycemic agents and reveals the long-term potential of positive metabolic memory for the prevention of microvascular, macrovascular, and other complications of diabetes in the long term.

Conclusion: It is necessary to overcome physicians’ clinical inertia in initiating and intensifying insulin therapy. The choice of basal insulin therapy regimen requires individualization for each individual case, taking into account the characteristics of the drugs and the clinical characteristics of the patients.

Background: Currently, diagnosing von Hippel-Lindau syndrome (VHL) is challenging due to its rarity, the diversity of clinical manifestations, and the lack of uniform diagnostic criteria. VHL is characterized by the development of various multiple neoplasms, including pheochromocytoma (PHEO), paraganglioma (PGL), and renal and pancreatic tumors.

Description of the clinical case: This article examines the clinical case of a patient with the onset of treatment-resistant arterial hypertension (AH) in adolescence.

The diagnosis of VHL was suspected based on the diagnosis of PGL and PHEO in both adrenal glands. The patient developed multiple neoplasms, including PGL and renal cell carcinomas, requiring surgical intervention. The patient’s VHL gene mutation is familial, and the genetic basis of the disease has also been confirmed in his sister.

Conclusion: This clinical case demonstrates the importance of diagnosing VHL as early as possible in young patients and their relatives, as well as the need for regular screening for the timely detection and treatment of developing neoplasms. Primary care physicians must be educated about the clinical manifestations, diagnosis, and monitoring algorithm for patients with VHL.

This article presents a two-year experience with inclisiran, a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, at the Sakhalin Regional Clinical Hospital. Lipid profile dynamics over a two-year follow-up period in 14 patients are described, demonstrating that triple lipid-lowering therapy (statin, ezetimibe, and inclisiran) reduced total cholesterol by 54%, low-density lipoprotein cholesterol (LDL-C) by 70.4%, and triglycerides by 49.6% from baseline. Information on reported injection site reactions that forced drug discontinuation in two patients is presented. Four clinical cases demonstrating the specific features of Inclisiran use are examined in more detail.

Background: The nutritional status (NS) of individuals with hyperlipoproteinemia (HLP), including parameters of body composition, energy metabolism, and macronutrient metabolism, has not been fully studied.

Objective: Determination of NS characteristics in individuals with different types of atherogenic HLP and development of an algorithm for the early diagnosis of lipid metabolism disorders and the development and progression of atherosclerosis.

Materials and methods: A NS study was conducted in 956 patients with cardiovascular diseases, divided into groups based on the type of hyperlipidemia. This study included anthropometric examination, examination of body composition, macronutrient/energy metabolism parameters, and NS biomarkers, as well as determination of the actual dietary patterns at home.

Results: Individuals with different types of atherogenic hyperlipidemia exhibit differences in their clinical status and NS, as well as the risk of developing complications. Therefore, accurate diagnosis of existing disorders and, accordingly, their timely correction are required.

Conclusion: A methodology for a step-by-step examination of individuals with dyslipoproteinemia at different stages of medical care in healthcare facilities in the Russian Federation has been developed and tested.