scholarly journals Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01.01.2021

2021 ◽  
Vol 24 (3) ◽  
pp. 204-221
Author(s):  
I. I. Dedov ◽  
M. V. Shestakova ◽  
O. K. Vikulova ◽  
A. V. Zheleznyakova ◽  
M. А. Isakov

BACKGROUND. One of the priority directions in the development of the health care system is to reduce the medical and social damage caused by the increase in the prevalence of diabetes mellitus (DM). From this point of view, the development of a diabetes register is very important as the main information and analytical platform for clinical and epidemiological monitoring of diabetes in the Russian Federation (RF).AIMS. The aim of our study was to analyze a dynamic (2016–2020) of the epidemiological characteristics of diabetes mellitus in the Russian Federation (prevalence, morbidity, mortality), the prevalence of complications, the level of HbA1c and the dynamics of the structure of glucose-lowering therapy (GLT) according to the Federal Diabetes Register (FDR).MATERIALS AND METHODs. The database of FRD (http://diaregistry.ru) 84 regions of the RF. The data are presented in dynamics 2016→2020.RESULTS. The total number of DM patients in the RF as of 01.01.2021 was 4,799,552 (3.23% of the population), including: Type 1 (T1) — 5.5% (265.4 ths) , T2 — 92.5% (4.43 million), other DM types — 2.0% (99.3 ths). The dynamics of prevalence was 168.7→180.9/100 ths people with T1, and 2709 → 3022/100 ths people with T2; morbidity in T1 10.5→7.7/100 ths population, in T2 219.6→154.2/100 ths population. Age and sex characteristics: the proportion of men in T1 — 54%, in T2 — 30%; the max proportion of patients with T1 at the age of 30–39 years, T2 65–69 years. Mortality: T1 3.0 → 2.7/100 ths population, T2 87.7→93.9/100 ths of the population, the main cause of death was cardiovascular: in T1 38,1% cases, in T2 — 52,0%. Life expectancy (average age of death of patients): T1 was 53.2years, the dynamics in males 50.7 → 50.5years, ­females 58.7→55.2years; in T2 — 73.5 years, males 70.2→70.1years, females 75.7→75.4 years. The dynamic of DM duration until the death: in T1 17.4→19.0 years; in T2 11→11.4 years. The incidence of diabetic complications in T1 and T2 patients: neuropathy 43.3% and 24.4%, nephropathy (CKD) 25.9% and 18.4%, retinopathy 31.7% and 13.5%, respectively. The ­proportion of ­patients with HbA1c <7%: in T1 32.3%→36.9%, in T2 51.9%→52.1%, with HbA1c ≥ 9.0% in T1 23.1%→18.7% , in T2 8.9%→8.0%. The structure GLT in T2 patients: glucose lowering medications (GLM) — 76.2% (monotherapy — 44.1%; ­combination of  2 GLM — 28.9%, 3 GLM — 3.2%), insulin therapy in 18,8%, without drug therapy in 4.9%.CONCLUSIONS. The performed analysis demonstrates the importance of dynamic assessment of epidemiological characteristics and monitoring of clinical data on patients with diabetes through a registry for assessing the quality of diabetes care and the prospects for its development.

2018 ◽  
Vol 21 (3) ◽  
pp. 144-159 ◽  
Author(s):  
Ivan I. Dedov ◽  
Marina V. Shestakova ◽  
Olga K. Vikulova ◽  
Anna V. Zheleznyakova ◽  
Michail А. Isakov

BACKGROUND: The enormous social lesion caused by high prevalence of diabetes mellitus (DM) determines the state importance of clinical and epidemiological monitoring organization. AIMS: To analyze epidemiological characteristics (prevalence, mortality, morbidity), the level ofHbA1c, evaluate the therapy in Russian Federation in 20132017. METHODS: We have used the database of the Russian Federal Diabetes register 81 regions included in the online register system. RESULTS: The total number of patients with DM was 4,498m. (3.06% RF population), including: Type 1 (T1) 5,7% (0,26 m), T2 92,1% (4,15m), other DM types 1,9% (83,8 ths). Distribution male/female: T1 53.5%/46.5%, T2 29%/71%, other DM types 24%/76%. The proportion of men decreases with aging. Number of patients 65 years was 2.293.520, including T1 21.97ths (3.6%), T2 2m271.5ths (54.7%). The prevalence 20132017 per 100,000 population was as follows: T1 159,8169,6; T2 2455.32775.6; other DM types 51,265,8. Morbidity: T1 9,87,0; T2 226,7185,2; other DM types 7,812,4. The structure of causes of death 20132017: T1: diabetic coma 2,01,5%, myocardial infarction 4,04,4%, cerebral circulation disorders 8,27,6%, cardiovascular insufficiency 18,516,4%, chronic renal failure 6,16,0%; T2 0,20,2%, 4,54,5%, 12,712,2%, 29,028,6%, 1,21,8%, respectively. Mortality: T1 2.3; T2 68.4, other DM types 0,8. Life expectancy (average age of death of patients): T1 male 50.350.2, female 60.257.2; T2 69.870.3, 75.175.9 respectively. The number of patients with targetHbA1clevel 7%: T1 22.334.0%, T2 38.052.4%;HbA1c9.0%: T1 29.221.1%, T2 12.68.8%. The most commonly prescribed classes of glucose lowering medications (GLM) in 2017: in monotherapy Metformin (57.3%), Sulfonilurea (SU) (41,1%); in combination of 2 GLM: Metformin+SU 92,58% Metformin+iDPP-4 5.63%; 3 or more GLM: Metformin+SU+iDPP-4 83,9%, Metformin+SU+iSGLT-2 8.98%. The proportion of patients on aGPP-1 therapy is 0.01%. CONCLUSIONS: We observed the growth of prevalence of DM in Russian Federation and decrease in registered morbidity rate; an increase in life expectancy in T2; decrease in mortality due to diabetic coms and stable mortality rate from cardiovascular events (heart attack, stroke, cv deficiency), gangrene, chronic renal failure in both types of DM; a steady improvement in glycemic control. In the structure of T2 therapy the oral GLMs are dominated, especially Metformin and SU. In the dynamics the prescription of Metformin, insulin, iDPP-4, iSGLT-2 has increased, the proportion of SU has decreased.


2019 ◽  
Vol 22 (2) ◽  
pp. 105-114 ◽  
Author(s):  
Viktor Y. Kalashnikov ◽  
Olga K. Vikulova ◽  
Anna V. Zheleznyakova ◽  
Mikhail А. Isakov ◽  
Irina Z. Bondarenko ◽  
...  

BACKGROUND: Cardiovascular diseases (CVD) are the main cause of death for patients with diabetes mellitus (DM). AIMS: To evaluate the CVD epidemiology: coronary heart disease (CHD), myocardial infarction (MI) and cerebrovascular diseases in adult patients with type 1 (T1DM) and type 2 (T2DM) diabetes, compare dynamics with data of implementation of the Federal Program Diabetes mellitus in 20072012 and over the online period 20132016. MATERIALS AND METHODS: The database of the Federal Diabetes register (81 regions at 12.2017). We estimated prevalence and incidence rates/10 thousand (th) adult DM patients over 18 years. RESULTS: The prevalence of CVD for the period 2007 2016 significant decreased in CHD for T1DM from 14,9% to 3,5%, for T2DM from 20,1% to 11,7%; MI for T1DM from 5,7% to 1,3%, for T2DM from 7,6% to 3,5%; cerebrovascular diseases for T1DM from 4,9% to 1,7%, for T2DM from 7,6% to 4,3%, respectively. In 20132016 positive trends continued: MI for T1DM 8,25,9/10th patients, for T2DM 19,214,7/10th patients, respectively; CVD for T1DM 11,310,5, for T2DM 29,425,4/10th patients, respectively. There was a large heterogeneity of the prevalence of CVD in the regions. MI varied in patients for T1DM from 319/10 th patients to absence, for T2DM from 800 to 7/10 th patients; the development of cerebrovascular diseases for T2DM from 900 to less than 100/10 th patients, which is largely due to differences in their registration. A small number of cases may be due to insufficient filling of the database, the facts of a huge number require further analysis. The average age of development of MI had increased: for T1DM 51,253 years, for T2DM 63,565 years, cerebrovascular diseases for T1DM 52,352.5 years, for T2DM 65,266,5, respectively. CONCLUSIONS: The prevalence of CVD significantly decreased in the Russian Federation compared to 20072012, as well as for the period 20132016: the prevalence of CHD and cerebrovascular diseases declined, the number of new cases of MI decreased, the average age and duration of DM before the development of CVD significantly increased. These data reflect the results of the program for improvement medical care and prevention measures for patients with diabetes.


Author(s):  
N.S. Alkhateeb, ◽  
◽  
M.A. Frolov ◽  
V.V. Shklyaruk ◽  
K.N. Odinaeva ◽  
...  

The number of patients with diabetes mellitus in the Russian Federation on January 1, 2019 is more than 4.5 million people, which is 3.12% of the population of the Russian Federation. Metabolic disorders in diabetes mellitus cause physicochemical changes, including a violation of acid-base balance (pH). Aim. To study the effect of diabetes mellitus and ocular prosthetics on the acid-base balance of the prosthetic cavity. Materials and methods. From 2018 to 2021 - 185 patients of both sexes from 21 to 80 years old (57.73±17.34 years old) were examined. 47 patients using an eye prosthesis and without diabetes mellitus (group I); 93 patients using an eye prosthesis with diabetes (group II), which were divided into two subgroups depending on the level of glycated hemoglobin (HbA1c): II-a subgroup - 47 patients with HbA1c up to 7.5%, II-b group – 46 patients with HbA1c more than 7.5%; 45 patients, without an eye prosthesis and without diabetes mellitus (group III). Results. In patients with an ocular prosthesis and without diabetes, a shift in pH to the side of acidosis was observed. In patients with an ocular prosthesis and with diabetes mellitus, the greatest shift in the pH of the conjunctival cavity to the side of acidosis, depending on the level of HbA1c (8-8.5 – in 25.8% of cases, 9-9.5 – in 43% of cases, and <10 – in 31.2% of cases). Conclusions. The presence of an ocular prosthesis in the conjunctival cavity leads to a shift in pH to the side of the alkaline side. The progression of the pH shift to the side of acidosis directly depends on the HbA1c level in patients, and the combination of two factors (the use of an ocular prosthesis in the conjunctival cavity and the presence of diabetes in the anamnesis) leads to an aggressive shift in the pH of the conjunctival cavity to the side of acidosis. Key words: acid-base balance, ocular prosthesis, diabetes mellitus.


2021 ◽  
Vol 24 (3) ◽  
pp. 300-309
Author(s):  
I. I. Dedov ◽  
G. A. Frank ◽  
N. G. Mokrisheva ◽  
M. V. Shestakova ◽  
G. A. Melnichenko ◽  
...  

Coding of the causes of death of patients with diabetes mellitus (DM) in the Russian Federation is one of the long-discussed problems, due to the comorbidity of diabetes and cardiovascular diseases (CVD) and a number of contradictions in the key regulatory documents regulating the statistics of mortality in this category of patients, which acquires particular relevance in the context of the coronavirus pandemic, due to its negative impact on the outcomes of the course of COVID-19 and mortality risks. In pursuance of the decisions of the Minutes of the meeting of the working group under the project committee of the National Project «Health» on identifying patterns in the formation of mortality rates of the population dated January 20, 2021 No. 1, chaired by Deputy Prime Minister of the Russian Federation T.A. Golikova, experts of two directions - endocrinology and pathological anatomy, prepared a Draft of agreed recommendations on the Rules for coding the causes of death of patients with diabetes, causing the greatest problems in terms of the use of ICD-10 when choosing the initial cause of death, including in the case of death from CVD and COVID-19.


2019 ◽  
Vol 21 (6) ◽  
pp. 444-454 ◽  
Author(s):  
Alexander Y. Mayorov ◽  
Olga K. Vikulova ◽  
Anna V. Zheleznyakova ◽  
Mikhail А. Isakov ◽  
Olga G. Melnikova ◽  
...  

Background: Despite the improvement in the quality of diabetes care in the Russian Federation (RF), coma remain one of the causes of death in patients with diabetes. Aim: To assess dynamic of epidemiological characteristic of acute complications in adult patients with T1D and T2D in 201316. Materials and methods: The database of the Russian Federal Diabetes register (81 regions). The indicators of coma for 201316 were estimated for 10000 adult patients with diabetes (18 years). Results: In 2016, the prevalence of coma in RF was 225.9 with T1D and 11.6/10000 adults with T2D. For the period from 2007 the prevalence of ketoacidotic coma decrease three times in T1D, 4 times for T2D.Totally in 2016, 165 new cases of coma for both types of diabetes were registered, an average of 0.4/10000 adults. Interregional differences in the prevalence of coma were observed 04.2/10000 adults. The frequency of new cases of coma has a tendency to decrease: 0,90,4/10000 adults: T1D 5.73.4, T2D 0.60.2/10000 adults. When evaluating the structure of coma, redistribution is evident in their form. So in 2016 the proportion of hypoglycemic coma increased to 40.7%, and ketoacidotic coma decreased to 56.6% in T1D. With T2D, the difference expressed in a lesser degree. The mean duration of diabetes at the time of coma development increased with T1D from 3.89.1 years, with T2D 3.57.0 years. The maximum frequency of development of coma is recorded with the diabetes duration more than 30 years, regardless of the type. The patients age at the time of coma development in T1D increased to 27.5 years old, and in T2D it was 60.4 years, it didnt change significantly. The assessment of glycemic control showed a significant improvement: a decrease in the proportion of patients with HbA1c 9.0% (23% with T1D, 8.8% with T2D), an increase with HbA1c 7% (32.4% and 51.7%, respectively). The average value of HbA1c in 2016 with T1D 8.21%, with T2D 7.48%. Conclusions: It is established that the dynamics of the frequency of development of coma in 201316 in adult patients with diabetes in the RF has a stable tendency to decrease: 1.5 times with T1D and more than 3 times with T2D. It can be assumed that this is due to the improvement in the quality of diabetes care and glycemic control in general, as well as the use of modern medicines. Attention is required to draw to the high frequency of coma in T1D, the development of coma with a longer duration of diabetes, an increase in the proportion of patients with hypoglycemic coma. Significant interregional differences in the frequency of coma registration require additional analysis.


2021 ◽  
Vol 25 (1) ◽  
pp. 19-25
Author(s):  
Ludmila N. Degtyareva

Worldwide, there is a high rate of growth in the incidence of diabetes mellitus. In the Russian Federation, the prevalence of diabetes is also high. According to some data, the number of patients with this disease in the Russian Federation can reach at least 9 million people (about 6% of the population). The most dangerous consequences of the global epidemic of diabetes mellitus are the development of its systemic vascular complications-nephropathy, retinopathy, lesions of the main vessels of the heart, brain, and arteries of the lower extremities. To prevent the development of complications of diabetes mellitus, its timely diagnosis is extremely important. Primary care physicians play a key role in early detection of diabetes. In this lecture, the risk factors for the development of diabetes mellitus, prevention of this disease, diagnostic approaches that allow timely detection of diabetes mellitus and start its treatment are considered. Diagnostic criteria for various disorders of the glycemic profile are presented. The role of glycated hemoglobin as a diagnostic criterion for diabetes mellitus is noted.


2017 ◽  
Vol 20 (1) ◽  
pp. 13-41 ◽  
Author(s):  
Ivan Ivanovich Dedov ◽  
Marina Vladimirovna Shestakova ◽  
Olga Konstantinovna Vikulova

Aim. We analysed the main epidemiological characteristics of diabetes mellitus (DM) in the Russian Federation (prevalence, incidence, mortality and mean life span), degree of diabetes control, and prevalence of diabetic complications (retinopathy, nephropathy, and diabetic foot syndrome and macrovascular pathology) according to the federal DM registry. Materials and methods. The database of the federal DM registry of 79 regions was included using the online system until 31.12.2016. Results. TThe total number of patients with DM in the Russian Federation on 31.12.2016 was 4.348 million (2.97% of the population), comprising 4 million patients with DM2 (92%), 255,000 with type 1 diabetes (T1DM) (6%), and 75,000 with other types of DM (2%). DM prevalence per 100,000 population was as follows: T1DM, 164.19/100,000; type 2 diabetes (T2DM), 2637.17/100,000; and other types of DM, 50.62/100. The incidence per 100,000 population was as follows: T1DM, 16.15/100,000; T2DM, 154.9/100,000; and other types of DM, 8.65/100,000. Mortality per 100,000 population was as follows: T1DM, 2.1/100,000; T2DM, 60.29/100,000; and other types of DM, 0.57/100,000. Mortality decreased in patients with T1DM by 6.6% and with T2DM by 3.6%. Mean life span in patients with T1DM was 50.3 years for men and 58.5 years for women. Mean life span in patients with T2DM was 70.1 years for men and 75.5 years for women. Glycated haemoglobin A1c (HbA1c) levels in T1DM was 7% in 33.4%, 7%7.9% in 28.3%, 8%8.9% in 16.2%, and 9.0% in 22.1% of patients. HbA1c levels in T2DM was 7% in 52.1%, 7%7.9% in 29.1%, 8%8.9% in 10%, and 9.0% in 8.7% of patients. Conclusions. This study evaluated the increase in DM prevalence in the Russian Federation in 2016 and in the dynamics of 20132016, which was mainly due to T2DM. An increase in patients with a target HbA1c level 7% and a decrease in the proportion of patients with severe uncontrolled DM was observed; however, the treatment effectiveness of this key indicator was unsatisfactory, i.e. less than a third of the patients with DM. In the dynamics of 20132016, an increase in mean life span for patients with T2DM and mortality reduction in patients with T1DM and T2DM was observed. The frequency of diabetic complications varied widely, which may reflect differences in the quality of specialised care in different regions.


2019 ◽  
Vol 91 (10) ◽  
pp. 4-13 ◽  
Author(s):  
M V Shestakova ◽  
O K Vikulova ◽  
A V Zheleznyakova ◽  
M A Isakov ◽  
I I Dedov

The National diabetes register (NDR) was created as unified dynamic database in online format. It allows providing clinical and epidemiological monitoring of diabetes mellitus (DM) in the whole country. Aim. To analyze the epidemiological characteristics of diabetes over the past decade, to access the dynamics of the prevalence of acute (coma) and chronic (micro - and macrovascular) complications of DM. Materials and methods. The object of the study was the depersonized NDR database of DM patients. It consists of 84 regions of the Russian Federation (RF), included in the online registry system on 01.01.2019. Results and discussion. The total number of patients with DM in RF on 01.01.2019 was 4 584 575 (3.12% of the population), comprising 256.2 thousand patients with T1DM, 4.24 million with T2DM, 89.9 thousand other types of DM. Since 2000, the number of DM patients in RF has grown 2.2 times. 34.7% patients with T1DM reached target level of HbA1c


2018 ◽  
Vol 21 (4) ◽  
pp. 230-240 ◽  
Author(s):  
Dmitry V. Lipatov ◽  
Olga K. Vikulova ◽  
Anna V. Zheleznyakova ◽  
Mikhail А. Isakov ◽  
Elena G. Bessmertnaya ◽  
...  

Background: Diabetic retinopathy (DR) is one of the most common causes of blindness in patients with diabetes mellitus (DM) that is why its necessary to study the epidemiological characteristics of this complication. Aims: The aim of the study was to evaluate the epidemiological characteristics of DR and blindness in adult patients with type 1 (T1) and 2 (T2) diabetes in Russian Federation (RF) for period 201316years. Materials and methods: Database of Federal Diabetes register, 81st regions included in the online register. Indicators were estimated per 10,000 adult DM patients (18years). Results: In 2016 the DR prevalence in RF was T1 38,3%, T2 15,0%, with marked interregional differences: 2,666,1%, 1,146,4%, respectively. The DR prevalence within 20132016 years was: T1 3830,93805,6; T2 1586,01497,0. Trend of new DR cases/per year increased: T1 153,2187,8; T2 99,7114,9. The structure of new cases of DR in 2016: non-proliferative stage (T1 71,4%, T2 80,3%), pre-proliferative stage 16,4%, 13,8%, proliferative 12,1%, 5,8%, terminal 0,2%, 0,1%, respectively, these data indicated the earlier detection of DR. The mean age of DR diagnosis increased: T1 by 1,2 years, T2 by 2,6. The average DM duration of DR determine increased T1 9,613,1 years, T2 6,09,1. The prevalence of blindness tends to decrease: T1 92,390,8; T2 15,415,2/10.000 DM adults. The amount of new cases of blindness/per year increased: T1 4,34,6; T2 1,21,4. The mean age of blindness increased: T1 39,141,6 years, T2 64,467,4; the mean duration of diabetes before blindness occur (from the time of DM diagnosis) increased: T1 20,221,2 years, in T2 10,711,3. We observed growth of DR treatment (laser surgery, vitrectomy, anti-VEGF medication) but the frequency of use in T2 patients is about 2 times less than in T1. Conclusions: There was a decrease in the overall incidence of eye damage in diabetes (DR and blindness) in the analyzed period in RF. DR and blindness develops at advanced age and with a longer duration of diabetes. As the main directions of eye care development in diabetes it is necessary to standardize primary care in the regions, to unify the examination algorithms and methods of early diagnostic, to increase the continuity and interaction of endocrinologists and ophthalmologists in managing patients with diabetes in order to prevent the development of new cases of vision loss.


2020 ◽  
Vol 10 (1) ◽  
pp. 66-69
Author(s):  
Natalia Zhavoronkova ◽  
Vyacheslav Agafonov

The article is devoted to the study of modern theoretical and legal problems of ensuring biological security in the Arctic zone of the Russian Federation. The published Draft of Federal law No. 850485-7“On biological security of the Russian Federation”provides an opportunity to take a closer look at the problem of legal provision of biological security in relation to the most vulnerable ecosystems, and, first of all, the Arctic. The article considers the most important features and potential risks of the Arctic zone of the Russian Federation of critical importance from the point of view of biological hazards, the features (specificity) of biological safety problems from the point of view of organizational-legal features and, in particular, from the perspective of environmental law. It is proved that, given the special situation of the Arctic zone of the Russian Federation, in addition to the base Federal law“About biological safety” required a specific law on biological and ecological safety of the Arctic zone of the Russian Federation, which should be generated on a slightly different model than the draft Federal law «On biological safety”, to wear the most specific, applied nature.


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