Experience in the integrated use of organizational approaches and clinical tools to achieve glycemic control goals

Background. The high prevalence of diabetes mellitus (DM) and the rapid increase in the number of patients have a significant impact on the healthcare systems of all countries of the world. A high risk of developing complications of diabetes, leading to disability and death of patients, is a source of additional costs for the treatment of this disease. The achievement and maintenance of target values of glycemic control, determined by the glycated hemoglobin (HbA1c) level, is considered as the most important measure to prevent the development of complications of diabetes. Despite all the modern possibilities for the treatment of diabetes, there are patients with an HbA1c level that significantly exceeds the target values in any dispensary group. Any approaches that can lead to a decrease in the HbA1c level in these patients should be actively used in real practice. The Federal Diabetes Register (FDR) is a database of personified records of diabetic patients. Using this database, it is possible to carry out activities that are specifically aimed at active management of patients who have the worst glycemic control indicators. Objective. An attempt to achieve reduction in the number of diabetic patients with a HbA1c level of >11.0% in the practice of treating diabetes at the outpatient level of the endocrinological service using a complex of organizational approaches and clinical tools. Methods. A sample was formed from the Moscow segment of the FDR, and included 417 patients with type 1 diabetes mellitus (DM1) and 3 584 patients with type 2 diabetes (DM2) with an HbA1c level of >11.0%. The Moscow Healthcare Department sent an order to outpatient sites (where these patients were followed-up) to carry out activities aimed at improving glycemic control indicators (intensification of ongoing therapy, referral to training at the Diabetes School, hospitalization in the endocrinology unit of a hospital, etc.) with subsequent determination of the HbA1c level at 3 and 6 months. Results. After 6 months of follow-up, 285 DM1 patients (95.3% of the number of patients who had data on the HbA1c level [n=299]) had HbA1c level <11.0%. Only in 4.7% (14 people) of DM1 patients, the HbA1c level was >11.0% after 6 months of observation. Also, 97.5% of DM2 patients (among the patients who had data on the HbA1c level during follow-up [n=2 948]) reached a HbA1c level <11.0% after 6 months of observation, and only 2.5% had a HbA1c level >11.0%. The baseline mean HbA1c level was 12.6% in DM1 patients (n=417) and 12.3% in DM2 patients (n=3 584). After 6 months of follow-up, this indicator decreased to 8.5% in DM1 patients (n=299), and to 8.2% in DM2 patients (n=2 948). Conclusion. Comprehensive measures, including organizational approaches and clinical tools used on the basis of personalized records of diabetic patients, allow to achieve a significant improvement in carbohydrate metabolism in most patients.

diabetes mellitus, Federal Diabetes Register, glycated hemoglobin