Outpatient care formalization and informatization for patients with diabetes mellitus

Первышин, Н.А.; Лебедева, И В; Lebedeva, Elena A.

doi:10.17116/profmed20212403114

Cited by 4 publications

(1 citation statement)

References 7 publications

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“…Для сбора и систематизации первичного клинического материала использована оригинальная программа для ЭВМ "Автоматизированное рабочее место эндокринолога для амбулаторного приема пациентов" (АРМЭ 2.0) 1 , которая обеспечивает сбор и сохранение первичных медицинских данных пациента непосредственно во время амбулаторного приема и их систематизацию в виде структурированного электронного медицинского документа (СЭМД) [5]. В матрице формализованного протокола консультации АРМЭ [6] отражено 69 показателей клинического статуса, среди которых можно выделить 2 группы:…”

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Clinical calculator for the prognosis of rapid progression of chronic kidney disease in patients with type 2 diabetes mellitus

Первышин

Lebedeva

Bulgakova

et al. 2023

jour

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Aim. To develop an applied clinical calculator for the prognosis of rapid progression of CKD in patients with type 2 diabetes, which allows to identify a group of patients at risk of a high rate of decrease in GFR of diabetes in outpatient admission, to assess its informativeness, resolution and diagnostic significance.Material and methods. A single-stage cross-observational study of clinical status indicators was performed in a population sample of patients with type 2 diabetes. Primary medical data were collected using the AWPE 2.0 program; 150 protocols of outpatient consultations, including 69 clinical indicators, were selected according to the compliance criteria. Based on the results of a comprehensive analysis of the relationship between the indicators of clinical status and the stages of development of CKD in type 2 diabetes, the most significant factors of progression of diabetic kidney damage are identified; the original diagnostic parameter "GFR reduction Index" is proposed and clinically justified, which allows to give an objective quantitative characteristic of the dynamics of the pathological process; the measure of the influence of diagnostically significant predictors on the rate of GFR reduction is determined by regression analysis; a logistic model is constructed, on the basis of which a prognostic calculator for rapid progression of CKD is developed.Results. Quantitative assessment of the contribution of individual clinical indicators to the rate of progression of CKD allowed us to identify the following significant factors: duration of diabetes and insulin therapy, acute myocardial infarction in history, age, BMI, concomitant retinopathy, pulsation on the popliteal artery, risk group IV hypertension, treatment with sulfonylureas (without differentiated assessment by pharmacological groups), calcium antagonists; when evaluating the informativeness and predictive ability of the calculator, the area under the AUC ROC curve was 0,90 (0,82; 0,98), p<0,001, which characterizes the quality of the diagnostic technique as very high.Conclusion. The original diagnostic parameter "Glomerular filtration Rate reduction Index" allows us to get a more detailed and accurate idea of the patterns of progression of CKD in DM, the applied clinical calculator of rapid progression of CKD allows us to identify a group of patients at risk of a high rate of GFR reduction, with a high level of diagnostic significance in outpatient settings.

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Clinical calculator for the prognosis of rapid progression of chronic kidney disease in patients with type 2 diabetes mellitus

Первышин

Lebedeva

Bulgakova

et al. 2023

jour

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The prospect of using a workstation by an endocrinologist for telemedicine counseling

Первышин

2022

Science and Innovations in Medicine

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The article provides a review of legislative acts, scientific articles, conference papers devoted to the problems of clinical use of telemedicine counseling. The official regulations of interactive telemedicine, the portals used for this service, formats, modes, payment methods were in the focus of our research. We analysed several examples of the telehealth services provided in the Russian Federation and abroad. Thus, we managed to identify the factors that, according to expert opinion, limit the widespread implementation of telemedicine counseling in clinical practice. We also gave general evaluation of the prospects of using an endocrinologist's workstation for consulting outpatients with diabetes mellitus for remote "doctor patient" interaction and for clinical case teleconferences, as well as for integration of the formalized protocol, lying in the software basis, into fully functional medical and administrative information systems existing in the medical institution. A short example of the 3-year regular use of a workstation for admission of outpatients with diabetes mellitus in a city polyclinic illustrates the advantages of this method.

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Mathematical modeling of the chronic kidney disease progression rate in patients with type 2 diabetes mellitus

Pervyshin

2024

Science and Innovations in Medicine

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The aim: development and clinical substantiation of experimental mathematical models of the rate of progression of chronic kidney disease (CKD) in type 2 diabetes mellitus (DM) using the original diagnostic parameter glomerular filtration rate reduction index (RI_GFR). Material and methods: a cross-sectional observational study of clinical status indicators in a population sample of patients with type 2 diabetes was performed, significant predictors of a high rate of CKD progression were identified by regression analysis, three variants of experimental mathematical models with different combinations of arguments with an emphasis on modifiable factors were constructed. Results: the method of one-dimensional logistic regression analysis revealed indicators of clinical status that have a significant impact on the rate of progression of CKD on the scale of changes in RI_GFR by 1 ml/min/1.73 m2 and on the binary classification of outcomes in the groups of "slow" and "fast" decrease in filtration function of the kidneys with a threshold value of RI_GFR of 4.21 ml/min/1.73 m2 per year: age, body mass index (BMI), glycemia at the reception, duration of diabetes at the time of consultation, experience of insulin therapy, acute myocardial infarction in the anamnesis, pulse on the popliteal artery, concomitant retinopathy, risk group of hypertension, treatment with sulfonylureas and calcium antagonists. Using multidimensional logistic regression, three types of experimental mathematical models were constructed, including various combinations of predictors that demonstrated high values of diagnostic significance. Conclusions: mathematical modeling of the progression of CKD in type 2 diabetes with the use of the RI_GFR diagnostic index allows us to get new ideas about the patterns of development of the pathological process; an experimental mathematical model, including modifiable drug factors that a doctor can influence during treatment (administration of sulfonylureas and calcium antagonists), showed the following characteristics: sensitivity 55.6%; specificity 85.3%, AUC 0.76 (0.65; 0.86), which ensures high quality prediction with an accuracy of 77.5%.

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Outpatient care formalization and informatization for patients with diabetes mellitus

Cited by 4 publications

References 7 publications

Clinical calculator for the prognosis of rapid progression of chronic kidney disease in patients with type 2 diabetes mellitus

Clinical calculator for the prognosis of rapid progression of chronic kidney disease in patients with type 2 diabetes mellitus

The prospect of using a workstation by an endocrinologist for telemedicine counseling

Mathematical modeling of the chronic kidney disease progression rate in patients with type 2 diabetes mellitus

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