Likelihood Of Transition Research Articles

Depression or anxiety symptoms associated with occupational role transitions in Brazilian adults with a traumatic spinal cord injury: A multivariate analysis.

Psychological morbidity is commonly experienced by people with a spinal cord injury (SCI), but whether it is associated with occupational role transitions in is unknown. To analyze whether anxiety or depression symptoms are independently associated to increased likelihoods of role transitions in adults with SCI. Cross-sectional study; multivariate analysis using a heteroscedastic Dirichlet regression. Thirty persons with traumatic SCI. Role Checklist (e.g. role transitions: dependent variables) and Beck's Depression Inventory and State-Trait Anxiety Inventory (independent variables), adjusted for socio-demographic, functional, and injury-level confounders. Greater depression symptoms independently increased the likelihood of occupational role transitions, either for roles loss [adjusted Odds Ratio (AOR): 1.04; 95% confidence interval (CI):1.009-1.080] or roles gain [AOR: 1.07; 95% CI:1.02-1.13], as opposed to continued occupational roles. Higher anxiety as a trait, in turn, independently reduced the likelihood of occupational roles gain [AOR: 0.93; 95% CI: 0.869-0.992]. The "worker" role was the one lost more frequently (83%). Psychological morbidity is associated to occupational role transitions, as opposed to continued roles. Further research (e.g. with larger samples, longitudinal design, using structural equation modelling) should elucidate on the intricate relationships between mental health status and occupational role transitions in people experiencing SCI.

571 Palliative Care Utilization in Burn Patients

Abstract Introduction The morbidity and mortality of the severely burned patient can be affected by multiple variables. Many of these variables are also associated with an increased likelihood of withdrawal of care. Palliative care services can aid families in difficult decision making during this time and improve the process of transition to comfort cares. Despite this, palliative care services may be underutilized. The aim of our study is to assess factors associated with palliative care consultation in the setting of severe burns. Methods We analyzed 191 patients with a burn TBSA of ≥30% at our institution from 2007 to 2019. Univariate and multivariate analysis was performed to identify factors associated with consultation to palliative care. Results 17 of the 191 (8.9%) patients received a palliative care consultation. The average time to consultation was 10.3 days. On univariate analysis, age, inhalation injury, multiple comorbid conditions, and code status were associated with consultation to palliative care. Independent predictors of palliative care consult included inhalation injury, non-white race, code status, and ventilator days. Conclusions Palliative care consultation appears to be seldomly requested at our facility. The presence of an inhalation injury and comorbidities increase the likelihood of consultation. These factors correspond to the same factors that increase likelihood of transition to comfort care. Consult to palliative care on patients with these factors can help improve patient and family care.

How far in the future can we predict others’ affective states?

IntroductionHuman social interactions are rooted in the ability to understand and predict one’s own and others emotions. Individuals develop accurate mental models of emotional transitions (MMET) by observing regularities in affective experiences (DOI: 10.1073/pnas.1616056114) and a failure in this regard can produce maladaptive behaviors, one of the hallmark features in several psychiatric conditions.ObjectivesTo investigate whether MMET are stable over time and which emotion dimensions (e.g., valence, dominance) influence MMET over time.MethodsWe selected thirty-seven emotion categories (DOI: 10.1177/0539018405058216) and five different time intervals (from 15 minutes to 4 days). Sixty-two healthy participants rated the likelihood of transition between all possible pairs of affective states at each time interval.ResultsAs expected, we observed a trend toward uncertainty as the timescale increased. In addition, the probability of shifting between two affective states having the same valence (e.g., happiness and contentment) was rated higher than for emotions with opposite polarity (e.g., happiness and sadness). Even though this pattern becomes gradually noisier for predictions far in the future, it is still present for infradian intervals (Fig.1).ConclusionsOur results suggest that MMET are informed by the valence dimension and moderately influenced by the timescale of the prediction. These findings in the healthy population may prompt the exploration of emotion dynamics in psychiatric conditions. Future studies could leverage the MMET approach to test whether specific psychiatric disorders (e.g., bipolar disorder) are associated with abnormal patterns of emotion transitions.DisclosureNo significant relationships.

Вплив глобальних криз на економічну безпеку країн світу

The article is devoted to the assessment of the impact of global crises on the economic security of the world. The selection of the main macroeconomic indicators is carried out, the economic content of their calculation is given. It is substantiated that the main such indicators are: balance of payments, the ratio of external debt to GDP, exchange rate volatility, the ratio of growth of international reserves and imports, unemployment. According to the needs of a particular economic situation, the list of indicators of early warning of the economic crisis can include a number of other macroeconomic indicators. It is emphasized that the control of the dynamics of indicators will make it possible to timely determine the probability of a systemic economic crisis and to develop effective management solutions to prevent the transition of the crisis from the local to the global state. It is substantiated that the synthesis of a quality system of global economic crisis control will help minimize the likelihood of crisis transition from the national sector to the global by timely detection and assessment of the first negative failures, development and implementation of management decisions to stabilize economic security. An economic and mathematical model for monitoring and assessing the impact of global crises on the economic security of the world has been developed. The model is based on the calculation of an integrated indicator of the number of risks, which describes the critical values of macroeconomic indicators in determining the onset of the economic crisis. Practical implementation of the control model will allow monitoring the implementation of control points of macroeconomic indicators and their calculation, as well as form a basis for developing appropriate management decisions to minimize the devastating effects of the crisis by early detection, prevention of crisis national economy and its transition to the global phase. A matrix of optimal values of the main macroeconomic indicators of world crises is proposed and calculated. The practical approbation of the control model was carried out on the example of the countries that had the largest share of world GDP in 2019. Among the developed countries, the USA (24.5%), Japan (5.8%) and Germany (4.41%) were selected with the largest share of GDP; among developing countries - China (16.8%) and India (3.27%). It is concluded that the most likely sources of economic disruption in the global sense are the United States and India.

Cost-effectiveness analysis with direct-acting antivirals in a cohort of HCV-infected inmates in Italy

Objective: To evaluate the cost-effectiveness of a strategy based on direct-acting antivirals (DAAs) versus no drug strategy in HCV-infected inmates, from the perspective of the Italian National Health System (iNHS).
 Methods: A previous Markov model was adapted to the Italian setting to evaluate the direct medical costs and health outcomes (quality-adjusted life years, QALY) throughout the life of HCV-infected inmates. Epidemiological data, patient characteristics (genotype, METAVIR classification), DAAs sustained virological response (SVR), annual likelihood of transition, treatment costs and utilities were gathered from the literature. The DAAs strategy included the administration of elbasvir/grazoprevir or sofosbuvir/velpatasvir or glecaprevir/pibrentasvir. Direct medical costs and QALYs were discounted at a 3.0% annual rate. Cost-effectiveness was evaluated as incremental cost-effectiveness ratio (€, 2019) per QALY gained. A deterministic sensitivity analysis (DSA) was performed.
 Results: Over a lifetime horizon, the DAAs strategy showed higher health costs per patient compared to no drugs strategy in the base-case analysis (€ 42,571 vs. € 26,119). However, it was associated with an increase of QALYs gained (21.14 vs. 15.67), showing an incremental cost-effectiveness ratio of € 3,010 per QALY. The sensitivity analysis confirmed the base-case results.
 Conclusions: Extending the DAAs treatment to HCV-infected inmates was estimated to be cost effective from the perspective of the Italian NHS, regardless genotype and METAVIR classification.

Cost-effectiveness analysis with direct-acting antivirals in a cohort of HCV-infected inmates in Italy

Objective: To evaluate the cost-effectiveness of a strategy based on direct-acting antivirals (DAAs) versus no drug strategy in HCV-infected inmates, from the perspective of the Italian National Health System (iNHS).
 Methods: A previous Markov model was adapted to the Italian setting to evaluate the direct medical costs and health outcomes (quality-adjusted life years, QALY) throughout the life of HCV-infected inmates. Epidemiological data, patient characteristics (genotype, METAVIR classification), DAAs sustained virological response (SVR), annual likelihood of transition, treatment costs and utilities were gathered from the literature. The DAAs strategy included the administration of elbasvir/grazoprevir or sofosbuvir/velpatasvir or glecaprevir/pibrentasvir. Direct medical costs and QALYs were discounted at a 3.0% annual rate. Cost-effectiveness was evaluated as incremental cost-effectiveness ratio (€, 2019) per QALY gained. A deterministic sensitivity analysis (DSA) was performed.
 Results: Over a lifetime horizon, the DAAs strategy showed higher health costs per patient compared to no drugs strategy in the base-case analysis (€ 42,571 vs. € 26,119). However, it was associated with an increase of QALYs gained (21.14 vs. 15.67), showing an incremental cost-effectiveness ratio of € 3,010 per QALY. The sensitivity analysis confirmed the base-case results.
 Conclusions: Extending the DAAs treatment to HCV-infected inmates was estimated to be cost effective from the perspective of the Italian NHS, regardless genotype and METAVIR classification.

Beta-2-glycoprotein-I IgA antibodies predict coronary plaque progression in rheumatoid arthritis

ObjectivesTo evaluate whether anti-Beta-2-Glycoprotein-I (anti-β2GPI) IgA antibodies associate with progression of coronary atherosclerosis and cardiovascular disease (CVD) events in rheumatoid arthritis (RA). MethodsOne hundred-fifty patients underwent plaque evaluation (total, non-calcified, mixed and calcified) with coronary computed tomography angiography; 101 were re-imaged within 6.9±0.3 years to assess progression. The Framingham-D'Agostino score assessed cardiovascular risk. Coronary artery calcium (CAC) and segment involvement score quantified plaque burden. ResultsAnti-β2GPI IgA were seen in 45 (30%) patients. Despite no link to baseline plaque burden, anti-β2GPI IgA associated with segment involvement score increase (adjusted-RR=1.64 [95%CI 1.02–2.63]), CAC change (adjusted-β=0.33 [95%CI 0.002–0.656]) and developing new extensive or obstructive plaque at follow-up (adjusted-OR=4.24 [95%CI 1.30–13.87]). Adding anti-β2GPI IgA to logistic regression models with conventional risk factors predicting plaque progression outcomes increased Area under the receiver-operator curve and improved Net Reclassification and Integrated Discrimination Improvement indices (all P<0.05). In per-segment analyses, anti-β2GPI IgA predicted mixed plaque formation (adjusted-OR=3.20 [95%CI 1.01–10.09]) and lower likelihood of transition of mixed to calcified plaque (adjusted-OR=0.19 [95%CI 0.04–0.96]). Anti-β2GPI IgA moderated the effect of C-reactive protein on CAC change such that C-reactive protein associated with CAC change (β=0.26 [95%CI 0.14–0.38]) and CVD risk (adjusted-HR=1.89 [95%CI 1.02–3.51]) only in anti-β2GPI IgA positive patients. ConclusionAnti-β2GPI IgA addition to clinical risk models improved prediction accuracy of CAC, plaque progression and transition to extensive/obstructive disease. They associated with new high-risk mixed plaques and delayed healing to calcified lesions. Anti-β2GPI IgA further modified the effect of inflammation on plaque progression and CVD events.

Sparse coupled logistic regression to estimate co-activation and modulatory influences of brain regions

Accurate mapping of the functional interactions between remote brain areas with resting-state functional magnetic resonance imaging requires the quantification of their underlying dynamics. In conventional methodological pipelines, a spatial scale of interest is first selected and dynamic analysis then proceeds at this hypothesised level of complexity. If large-scale functional networks or states are studied, more local regional rearrangements are then not described, potentially missing important neurobiological information. Here, we propose a novel mathematical framework that jointly estimates resting-state functional networks and spatially more localised cross-regional modulations. To do so, the changes in activity of each brain region are modelled by a logistic regression including co-activation coefficients (reflective of network assignment, as they highlight simultaneous activations across areas) and causal interplays (denoting finer regional cross-talks, when one region active at time t modulates the t to t + 1 transition likelihood of another area). A two-parameter regularisation scheme is used to make these two sets of coefficients sparse: one controls overall sparsity, while the other governs the trade-off between co-activations and causal interplays, enabling to properly fit the data despite the yet unknown balance between both types of couplings. Across a range of simulation settings, we show that the framework successfully retrieves the two types of cross-regional interactions at once. Performance across noise and sample size settings was globally on par with that of other existing methods, with the potential to reveal more precise information missed by alternative approaches. Preliminary application to experimental data revealed that in the resting brain, co-activations and causal modulations co-exist with a varying balance across regions. Our methodological pipeline offers a conceptually elegant alternative for the assessment of functional brain dynamics and can be downloaded at https://c4science.ch/source/Sparse_logistic_regression.git.

Knockin’ on the Bank’s Door: Why is Self-Employment Going Down?

This study analyzes a decline in the ability to obtain financing as a potential explanation for the observed decrease in the U.S. self-employment. The shrinking of the U.S. bank branch network since 2010 and the increased average borrower-lender distance reduce the accessibility of credit institutions for borrowers. To evaluate the impact of the CMA on entry into self-employment, I disaggregate the self-employed into two categories: entrepreneurs whose businesses depend on business loans (incorporated self-employed) and other self-employed (unincorporated self-employed). Using a novel data source (the Community Advantage Panel Survey database), I find that the proximity of credit market institutions has heterogeneous effects on the transition to self-employment. An improvement in the CMA increases the likelihood of transition to incorporated self-employment. But for the unincorporated self-employed, the effect is the opposite: the probability of transition to unincorporated self-employment decreases, and workers of this type are more likely to switch to paid employment to be able to receive non-business related loans. The paper discusses the implications of these results for different policies.

Creative and resourceful: How human, social, and psychological resources affect creative workers’ ability to rebound after failure

In this research, we use the resource-based view to explore how creative workers leverage individual-level intangible resources to transition after a setback. Empirically, we match two complementary data sources: 1474 project failures by creative workers seeking capital on Kickstarter.com and post-failure market transitions by these individuals (i.e., published works on Amazon.com ). Our results indicate that intangible human resources increase the likelihood and speed of post-failure transitions. We examine two moderating effects and find that intangible social resources strengthen this relationship, while intangible psychological resources weaken this relationship. These findings contribute to the emerging literature on creative work and transitioning after initial project failures. Moreover, resource-based view scholars have called for more research at the micro-level and in the early stages of resourcing. We therefore extend the resource-based view by considering the role of individual-level intangible resources at the earliest stages of creative development.

Mixed Symmetry States for even-even 218-224 Ra Isotopes by using (IBM-2)

In present investigation we employ IBM-2 parameters in Hamiltonian operator and applying the NPBOS bundle to determine mixed symmetry states for even-even 218-224 Ra isotopes, in addition to extract some theoretical nuclear properties, one of which the excited energy levels, which gave best match between practical data and theoretical results specially for the ground state bands, and acceptable agreement for semi β bands and semi γ bands. The (MSS) property which gets a speedy reaction while changing majorana term δ2 due to mixture between wave function for protons and neutrons was diagnosed for levels Energy ratios were calculated between and which shows these isotopes have a varied dynamic stretch starting from their pure vibrational state at A = 218 transition state U (5) - O (6) at A = 220 and finally transition state O (6)-SU (3), when A = 222 And 224, respectively. Finally, determined the likelihood for electric quadruple transition B(E2), magnetic dipole B(M1), which All express a decent agreement with the practical data.

Journal Digest: Acyl Ghrelin and PTSD; MH Appointment and Follow-up Care; Neurons and Dissociation; Fatty Acid and Autism

Journal Digest: Acyl Ghrelin and PTSD; MH Appointment and Follow-up Care; Neurons and Dissociation; Fatty Acid and Autism

Effect of Scheduling a Post-Discharge Outpatient Mental Health Appointment on the Likelihood of Successful Transition From Hospital to Community-Based Care.

This study examined a cohort of 15,520 inpatient psychiatric discharges to determine associations between scheduling an outpatient mental health appointment as part of discharge planning and attending outpatient care following discharge after control for patient, hospital, and system characteristics. 2012-2013 New York State Medicaid and other administrative databases were used to examine patients who were aged under 65 years, admitted to an inpatient psychiatric unit, and discharged to the community. Outcomes included attending an outpatient mental health service within 7 and 30 days following inpatient discharge. Scheduling a mental health outpatient appointment as part of the discharge plan was the primary predictor variable, and potentially confounding covariates were addressed by adjusting for propensity scores estimating the likelihood of having an outpatient appointment scheduled. Among 15,520 discharged patients, 11,945 (77%) had an outpatient appointment scheduled with a mental health provider as part of their discharge planning. After adjustment for propensity scores, patients who had an outpatient appointment scheduled were significantly more likely to attend an outpatient mental health service within 7 (OR = 1.69; 95% CI, 1.48-1.94) and 30 days (OR = 1.65; 95% CI, 1.42-1.93) compared to patients who did not have an appointment scheduled. Even among those with a low propensity to have an appointment scheduled, scheduling an outpatient appointment was associated with attending outpatient services. Scheduling an outpatient mental health appointment is an effective and low-resource discharge planning practice that should be an important target for inpatient psychiatric clinical quality measurement and improvement.

Will COVID-19 Cause a War? Understanding the Case of the U.S. and China

Abstract This study analyzes the possibility that COVID-19 will increase the risk of a military conflict between the United States and People’s Republic of China. The mechanism is that COVID-19 weakens American economic output, which undermines the U.S. capability to project force. This enables China’s efforts to revise the status quo. Although a rapid collapse of American power due to COVID-19 would theoretically increase the likelihood of an armed conflict, this scenario is unlikely due to the centrality of the U.S. dollar in the global financial system. I therefore argue that COVID-19 increases the short term risk of military crises, particularly in the South China Sea and Persian Gulf, but does not significantly increase the likelihood of a power transition and full scale war. However, the long term depends on the ability of the U.S. to respond adequately to the COVID-19 crisis.

Deformation transitions of ethylene-hexene copolymers under creep loading

Creep tests were conducted in the temperature range from 296 to 358 K, on three commercial ethylene-hexene copolymers (PE) with mass density of 0.938, 0.941 and 0.952 g/cc. PE with the highest density shows the well-known ductile-brittle (DB) transition in the relationship between applied stress and failure time, and PE with the medium density a different transition which was detected through the change in the dependence of failure time on the applied stress, but the failure mode remained ductile. Therefore, this transition is named ductile-ductile (DD). The work shows feasibility of establishing creep master curves to include the two transitions, and discusses exclusiveness between DD and DB transitions so that detection of the DD transition can be used to determine the likelihood of the DB transition to occur in the long-term service. The work also examines applicability of the Monkman-Grant relationship to PEs that involve DD or DB transition.

Optimizing Sequential Systemic Therapies for Advanced Hepatocellular Carcinoma: A Decision Analysis.

Background: An optimal sequential systemic therapy for advanced hepatocellular carcinoma (HCC) has not been discovered. We developed a decision model based on available clinical trials to identify an optimal risk/benefit strategy for sequences of novel systemic agents. Methods: A Markov model was built to simulate overall survival (OS) among patients with advanced HCC. Three first-line (single-agent Sorafenib or Lenvatinib, and combination of Atezolizumab plus Bevacizumab) followed by five second-line treatments (Regorafenib, Cabozantinib, Ramucirumab, Nivolumab, Pembrolizumab) were compared in fifteen sequential strategies. The likelihood of transition between states (initial treatment, cancer progression, death) was derived from clinical trials. Life-year gained (LYG) was the main outcome. Rates of severe adverse events (SAEs) (≥grade 3) were calculated. The innovative measure, called incremental safety-effectiveness ratio (ISER), of the two best sequential treatments was calculated as the difference in probability of SAEs divided by LYG. Results: Lenvatinib followed by Nivolumab (median OS, 27 months) was the most effective sequence, producing a LYG of 0.75, while Atezolizumab plus Bevacizumab followed by Nivolumab was the safest sequence (SAEs 40%). Accordingly, the net health benefit assessed by ISER favored Lenvatinib followed by Nivolumab, compared to Atezolizumab plus Bevacizumab, followed by Nivolumab in 52% of cases. Conclusion: Further sequential clinical trials or large-scale real-world studies may prove useful to evaluate the net health benefit of the best sequential treatment for advanced HCC.

Patterns and Predictors of Transitions Across Residential Care Settings and Nursing Homes Among Community-Dwelling Older Adults in the United States.

Older adults prefer to age in place, but sociodemographic, health, and socioeconomic factors may influence their decision to remain in the community. Guided by Andersen's behavioral model, we characterize incident transitions out of the community into residential care settings or nursing homes and identify predictors of these transitions. Study participants include 2,725 (weighted n = 13,704,390) community-dwelling U.S. older adults of the National Health and Aging Trends Study from 2011 to 2018. We examined the associations between sociodemographic, socioeconomic, and health factors and the probability of transition using a multinomial logit model. Over the study period, 86.2% of older adults remained in the community, whereas 9.0% and 4.9% transitioned to residential care settings and nursing homes, respectively. Older age, living alone, having functional and cognitive limitations, and hospitalization were associated with increased risk of transitioning to residential care settings or nursing homes from the community. Blacks and Hispanics were less likely to transition to residential care settings or nursing homes. Adults with lower income had a greater risk of transitioning to nursing homes. Medicaid enrollment did not affect the likelihood of transition. Majority of older adults remained in the community, and incident transition to residential care settings was more common than to nursing homes. Policy should target sociodemographic, health, and socioeconomic factors that enable older adults to age in place. Future work should examine whether these new residential care settings enhance the quality of life or result in subsequent transitions back into the community.

Inflexible adjustment of expectations affects cognitive-emotional conflict control in adolescents with autism spectrum disorder

Autism spectrum disorder (ASD) is marked by a range of challenges including cognitive and socio-emotional differences as well as difficulties to flexibly adjust to unpredictable situations. It has recently been suggested that people with ASD hold rigid expectations about upcoming events that tend to be shaped by information that is unlikely to repeat in the future. Prior expectations play an important role for proactive conflict control exemplified in the Gratton, or the congruency sequence effect (CSE). Here, we examine proactive cognitive-emotional conflict control in ASD compared to neuro-typical controls and the underlying neurophysiological and functional neuroanatomical processes using EEG methods and an emotional Stroop task with sequentially manipulated trial transitions. We show that, in ASD the presence of cognitive-emotional conflict in a previous trial affects the ability to process emotional conflict in a subsequent trial. That is, ASD individuals show a prominent CSE effect on emotional stimuli while neuro-typical controls do not. The neurophysiological data revealed that this proactive reconfiguration of stimulus-response associations during conflict resolution is associated with activation within anterior cingulate (BA24 and 32) and insular cortices (BA13). Purely perceptual, attentional and motor response-related processes could not explain these effects. Our results suggest that when faced with cognitive-emotional conflict, ASD individuals seem to rely on their subjective expectation about an upcoming trial type independent of the objective likelihood of that upcoming trial transition. The present results lend support to theoretical propositions on precision weighting of prediction error in ASD and have theoretical and clinical implications in the context of cognitive-emotional regulation and conflict control.

Type 2 diabetes: the second step of treatment

The main goal of treating patients with type 2 diabetes mellitus at the present stage is to influence the cardiovascular risks taking into account the assessment of heart and kidney function. The 2020 American Diabetes Association Recommendations emphasize that lifestyle modification and metformin use are still considered the cornerstones of treatment for type 2 diabetes. The leading role is given to metformin as the first line of pharmacological treatment of such patients. In a DPP study, it was shown that when combining lifestyle changes and prescribing metformin, the likelihood of transition of pre-diabetes to diabetes decreased by 89 %.With high hyperglycemia, the Recommendations of the American Diabetes Association in 2020 suggest starting treatment of type 2 diabetes mellitus with the so-called dual therapy. The combination of metformin and sulfonylurea (glimepiride) preparations is effective for the prevention of both macrovascular and microvascular complications; therefore, it is the most frequent combination in the world that is recommended for use as the first or second stage of treatment for patients with type 2 diabetes.Patients with diabetes have a very high risk of death with COVID-19 – the second place after cardiovascular complications, which are also characteristic of such patients. Management tactics for patients with diabetes mellitus and COVID-19 include increasing the amount of fluid consumed and discontinuing all drugs, including sugar-lowering drugs, which can negatively affect the cardiovascular system and kidneys due to dehydration and potentiation of acidosis. In viral infections, patients with diabetes can safely use sulfonylureas and insulin preparations, as well as metformin (with mild to moderate severity of COVID-19).

Type 2 diabetes: the first step in treatment

In 70 % of cases, diabetes is detected and treated on an outpatient basis at the primary level of medical care by general practitioners and general practitioners. Type 2 diabetes mellitus, which accounts for 90–95 % of all cases of diabetes in the structure of morbidity, is a disease of malnutrition and an unhealthy lifestyle. The 2020 American Diabetes Association Recommendations noted that type 2 diabetes is always preceded by prediabetes, which should be considered as a factor in the increased risk of developing both diabetes itself and cardiovascular diseases. Therefore, preventive treatment should begin already at the stage of prediabetes, when cardiovascular complications of the future disease are formed. Lifestyle modification (diet, increased physical activity) in combination with taking metformin reduces the likelihood of transition of diabetes to diabetes by almost 90 %.The global goal of treating patients with type 2 diabetes is to address cardiovascular risks, taking into account the assessment of heart failure and renal function. The combination of metformin and sulfonylurea preparations shows a cardio- and nephroprotective effect and is therefore the most frequent combination in the world recommended for use as the first or second stages of treatment for patients with type 2 diabetes. When initiating a hypoglycemic therapy, immediate release metformin should be preferred.