Standards of specialized diabetes care. Edited by Dedov II, Shestakova MV, Mayorov AY. 8th edition

Abstract

Dear Colleagues!
 We are glad to present the8th Editionof Standards of Diabetes Care. These evidence-based guidelines were designed to standardize and facilitate diabetes care in all regions of the Russian Federation.
 The Standards are updated on the regular basis to incorporate new data and relevant recommendations from national and international clinical societies, including World Health Organization Guidelines (WHO, 2011, 2013), International Diabetes Federation (IDF, 2011, 2012, 2013), American Diabetes Association (ADA, 2012, 2017), American Association of Clinical Endocrinologists (AACE, 2017), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014) and Russian Association of Endocrinologists (RAE, 2011, 2012, 2015). Current edition of the Standards also integrates results of completed randomized clinical trials (ADVANCE, ACCORD, VADT, UKPDS, SAVOR, TECOS, LEADER, EMPA-REG OUTCOME, etc.), as well as findings from the national studies of diabetes mellitus (DM), conducted in close partnership with a number of Russian hospitals.
 Latest data indicates that prevalence of DM in the world increased during the last decade more than two-fold, reaching some 415 million patients by the end of 2015. According to the current estimation by the International Diabetes Federation, 642 million patients will be suffering from DM by 2040. These observations resulted in the UN Resolution on Diabetes 61/225 passed on 20.12.2006, and in 2011 - UN Political Declaration, addressed to national health systems, calling for the establishment of multidisciplinary strategy in the prevention and control of non-communicable diseases, where special attention is drawn to the problem of diabetes as one of the leading causes of disability and mortality.
 Like many other countries, Russian Federation experiences a sharp rise in the prevalence of DM. According to Russian Federal Diabetes Register, there are at least 4.35 million patients with DM in this country by the end of 2016 (3% of population) with 92% (4 million) Type 2 DM, 6% (255 th) Type 1 DM and 2% (75 th) other types of DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) confirmed that only 50% of Type 2 DM are diagnosed. So real prevalence of patients with DM in Russia is no less than 8-9 million patients (about 6% of population). This is a great long-term problem, because a lot of patients are not diagnosed, so they dont receive any treatment ant have high risk of vascular complications.
 Severe consequences of the global pandemics of DM include its vascular complications: nephropathy, retinopathy, coronary, cerebral, coronary and peripheral vascular disease. These conditions are responsible for the majority of cases of diabetes-related disability and death.
 Current edition of the Standards emphasizes the patient-oriented approach in making decisions on therapeutic goals, such as levels of glycaemia and blood pressure. It also features updated guidelines on the management of Type 2 DM and its vascular complications, added information about bariatric surgery as a method of treatment of DM with morbide obesity.
 This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discussions held at national meetings and forums. These guidelines are intended for endocrinologists and diabetologists, primary care physicians, cardiologists and other medical professionals involved in prevention and treatment of DM.
 On behalf of the Working Group

Hypoglycemia after initiating insulin therapy based on the results of structured self-control and monitoring of blood glucose

“…Для практического использования в клини-ке наиболее широко используется пороговое значение в 3,9 ммоль/л, определенное как критерий гипогликемии рекомендациями Американской диабетической ассоциа-ции, хотя также предложены значения в 4,0; 3,5 и 3,0 ммоль/л [5,6]. В национальных российских Алгоритмах специализированной медицинской помощи больным с сахарным диабетом значение в 3,9 ммоль/л также при-нято как пороговое для начала мероприятий по купирова-нию гипогликемии для пациентов с сахарным диабетом 2-го типа, получающих сахароснижающую терапию [7].…”

“…Целевые уровни гликемии для графика были индивидуа-лизированы в соответствии с Алгоритмами специализи-рованной медицинской помощи больным сахарным диа-бетом [7]. Для проведения самоконтроля пациентам были выданы глюкометры Accu-Chek Active и тест-полоски.…”

Peculiarities of night EEG-monitoring of sleep in children with type 1 diabetes mellitus depending on the glycemia level

“…Показатель гликированного гемоглобина А1с (HbА 1с ) составил 8,1-15,8% (10,9% [9,[5][6][7][8][9][10][11][12]7]). Кардиова-скулярная автономная нейропатия (КАН) была диагностиро-вана у 4 больных на доклинической стадии.…”

Genetic parameters of wound healing in patients with neuropatic diabetic foot ulcers

“…Согласно текущим рекомендациям по ведению больных с СДС [12], все больные, включенные в исследование, полу-чали адекватную разгрузку пораженной конечности и ан-тибактериальную терапию. В ходе госпитализации у всех пациентов контроль гликемии был удовлетворительным с достижением индивидуальных целевых значений.…”