Standards of specialized diabetes care. Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 9th edition

Abstract

Dear Colleagues!
 We are glad to present the 9th Edition (revised) of 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, 2018, 2019), American Association of Clinical Endocrinologists (AACE, 2019), International Society for Pediatric and Adolescent Diabetes (ISPAD, 2014, 2018) 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, EXAMINE, ELIXA, SUSTAIN, DEVOTE, EMPA-REG OUTCOME, CANVAS, DECLARE, CARMELINA, REWIND, 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 463 million patients by the end of 2019. According to the current estimation by the International Diabetes Federation, 578 million patients will be suffering from diabetes mellitus by by 2030 and 700 million by 2045.
 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 4 584 575 patients with DM in this country by the end of 2018 (3,1% of population) with 92% (4 238 503) Type 2 DM, 6% (256 202) Type 1 DM and 2% (89 870) other types of DM, including 8 006 women with gestational DM. However, these results underestimates real quantity of patients, because they consider only registered cases. Results of Russian epidemiological study (NATION) con- firmed that only 54% of Type 2 DM are diagnosed. So real number of patients with DM in Russia is 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.
 In сurrent edition of the Standards:
 
 New goals of glycemic control for the elderly, based on the presence of functional dependence, as well as for pregnant women, children and adolescents, are given.
 Added a snippet that describes the continuous glucose monitoring.
 Only low-density lipoprotein cholesterol level is used as a target for lipid metabolism.
 Proposes more stringent target levels of blood pressure.
 It also features updated guidelines on stratification of treatment in newly diagnosed Type 2 diabetes: the excess of the initial level of HbA1c over the target level was used as a criterion.
 In the recommendations for the personalization of the choice of antidiabetic agents, it is taken into account that in certain clinical situations (the presence of atherosclerotic cardiovascular diseases and their risk factors, chronic heart failure, chronic kidney disease, obesity, the risk of hypoglycemia) certain classes of hypoglycemic agents (or individual drugs) have proven advantages.
 Recommendations for psychosocial support are added.
 The position of metabolic surgery as a method of treatment of DM with morbid obesity is updated.
 Recommendations for diagnostic and treatment of hypogonadism syndrome in men with DM are added.
 For the first time, evidence levels of confidence and credibility levels of recommendations for diagnostic, therapeutic, rehabilitative and preventive interventions based on a systematic review of the literature are given in accordance with the recommendations of the Center for Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation.
 
 This text represents a consensus by the absolute majority of national experts, achieved through a number of fruitful discus- sions held at national meetings and forums.
 These guidelines are intended for endocrinologists, primary care physicians and other medical professionals involved in the treatment of DM.
 On behalf of the Working Group

Molecular genetic markers and metabolic disorders in non-alcoholic fatty liver disease

“…Сравнительная оценка состояния углеводного обмена была проведена у 115 пациентов с НАЖБП согласно клиническим рекомендациям «Алгоритмы специализированной медицинской помощи больным сахарным диабетом» [16] (табл. 2).…”

Aldosterone Blood Level Influence on the Remodeling of Heart and Vessels in Patients With Type 2 Diabetes and Arterial Hypertension

“…Для достижения поставленной цели было обследовано 256 больных с СД 2 типа и АГ. Диагноз устанавливался в соответствии с «Алгоритмами специализированной медицинской помощи больным сахарным диабетом», 9-й выпуск (2019) [13] и клиническими рекомендациями «Артериальная гипертензия у взрослых (2020) [14] [17]. Полученные нами данные указывают на значимо большие значения жесткости артерий как в группе с уровнем альдостерона более 75-го процентиля, так и менее 25-го процентиля.…”

The effectiveness of laser therapy in patients with diabetic foot

“…Согласно прогнозам Международной диабетической федерации, к 2035 г. количество больных сахарным диабетом (СД) в мире увеличится до 592 млн человек. Синдром диабетической стопы (СДС) встречается у 20-80 % пациентов СД в возрасте от 22 до 78 лет [1][2][3][4][5][6]. Риск ампутации нижних конечностей у больных сахарным диабетом в результате развития гнойно-некротических осложнений СДС в 23 раза выше, чем у здорового человека [3,6].…”

“…Синдром диабетической стопы (СДС) встречается у 20-80 % пациентов СД в возрасте от 22 до 78 лет [1][2][3][4][5][6]. Риск ампутации нижних конечностей у больных сахарным диабетом в результате развития гнойно-некротических осложнений СДС в 23 раза выше, чем у здорового человека [3,6]. Около 40-60 % всех выполняемых нетравматических ампутаций производится у больных сахарным диабетом [2][3][4].…”

“…Риск ампутации нижних конечностей у больных сахарным диабетом в результате развития гнойно-некротических осложнений СДС в 23 раза выше, чем у здорового человека [3,6]. Около 40-60 % всех выполняемых нетравматических ампутаций производится у больных сахарным диабетом [2][3][4]. В настоящее время в клинической практике используются различные методы лечения гнойно-некротических осложнений СДС, такие как гипербарическая оксигенация, терапия отрицательным давлением (NPWT, VAC-therapy), применение тканевых факторов роста, лазеротерапия [1,7,8].…”