Bene dignoscitur, bene curatur: Analysis of implementation of diagnostic and therapeutic measures for pre-diabetes management in clinical practice conditions (according to the data of the REGION-M hospital and outpatient register)

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Abstract

Timely diagnosis of pre-diabetes (early carbohydrate metabolism disorders) and prevention of progression of this condition to diabetes mellitus (DM) are vital, especially for patients with cardiovascular diseases and their complications.

The aim: to determine the proportion of patients with impaired glucose tolerance (IGT, pre-diabetes) in a cohort of patients who suffered an acute cerebrovascular accident (ACVA), as well as the diagnostic peculiarities of this condition at different stages of observation and the frequency of metformin prescription for the prevention of type 2 diabetes mellitus.

Material and methods. In the frames of the register of patients who suffered an ACVA in 2012–2017, case histories and discharge summaries after the reference ACVA (n = 900), as well as outpatient cards of patients (n = 684) were analyzed. At in-hospital and outpatient stages of observation, that was completed in 2022, the number of patients diagnosed with IGT, frequency of metformin prescription to these patients, and achievement of the primary endpoint (total mortality) were determined.

Results. IGT diagnosis (according to the anamnesis data) was present in 81 (9.0%) of 900 hospitalized patients, in 87 (9.8%) of 684 discharged patients (according to the discharge summary data), in 63 persons (9.2%) diagnosis of IGT was confirmed at the outpatient observation stage. Due to discrepancy in the established diagnoses of IGT and diabetes mellitus at different stages of observation the overdiagnosis of these conditions during inpatient treatment was found. Metformin treatment was recommended only for 3.2% of patients with IGT. Higher mortality was characteristic of patients with diabetes mellitus comparatively to the groups of patients without glycemic disorders and with IGT, and only at the hospital observation stage (p < 0.05).

Conclusion. The frequency of IGT in the studied cohort averaged 9%. Significant discrepancies in establishing IGT diagnosis at hospital and outpatient stages of observation were revealed. Frequency of metformin prescription (a drug with a reliable evidence base for the prevention of diabetes) to patients with IGT at the outpatient stage was very low (3.2%).

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About the authors

Yulia V. Lukina

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia

Author for correspondence.
Email: yuvlu@mail.ru
ORCID iD: 0000-0001-8252-3099

MD, Dr. Sci. (Medicine), leading researcher at the Laboratory of pharmacoepidemiological research of the Department of preventive pharmacotherapy

Russian Federation, 101990, Moscow, 10/3 Petroverigsky Lane

Alexander V. Zagrebelny

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia

Email: azagrebelny@mail.ru
ORCID iD: 0000-0003-1493-4544

MD, PhD (Medicine), senior researcher at the Department of preventive pharmacotherapy

Russian Federation, 101990, Moscow, 10/3 Petroverigsky Lane

Natalya P. Kutishenko

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia

Email: nkutishenko@gnicpm.ru
ORCID iD: 0000-0001-6395-2584

MD, Dr. Sci. (Medicine), head of the Laboratory of pharmacoepidemiological research of the Department of preventive pharmacotherapy

Russian Federation, 101990, Moscow, 10/3 Petroverigsky Lane

Victoria P. Voronina

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia

Email: vvoronina@gnicpm.ru
ORCID iD: 0000-0001-5603-7038

MD, PhD (Medicine), senior researcher at the Department of preventive pharmacotherapy

Russian Federation, 101990, Moscow, 10/3 Petroverigsky Lane

Sergey Yu. Martsevich

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia

Email: sergeymartsevich@mail.ru
ORCID iD: 0000-0002-7717-4362

MD, Dr. Sci. (Medicine), professor, head of the Department of preventive pharmacotherapy

Russian Federation, 101990, Moscow, 10/3 Petroverigsky Lane

Ruslan N. Shepel

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia

Email: RShepel@gnicpm.ru
ORCID iD: 0000-0002-8984-9056

MD, PhD (Medicine), deputy director for prospective development of medical activities

Russian Federation, 101990, Moscow, 10/3 Petroverigsky Lane

Oksana M. Drapkina

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia

Email: ODrapkina@gnicpm.ru
ORCID iD: 0000-0002-4453-8430

MD, Dr. Sci. (Medicine), professor, academician of RAS, director

Russian Federation, 101990, Moscow, 10/3 Petroverigsky Lane

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Supplementary files

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2. Fig. 1. Kaplan — Meyer curves for groups with no glycemic disorders, impaired glucose tolerance, and diabetes mellitus at the hospital follow-up stage

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3. Fig. 2. Kaplan—Meyer curves for groups of patients with no glycemic disorders, impaired glucose tolerance, and diabetes mellitus at the outpatient follow-up stage

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