The 20-year clinical follow-up of patients who had fallen ill with T1DM in childhood showed that diabetic microangiopathies developed with the long-term preservation of poor blood glucose control (BGC) starting at the onset of the disease. At the same time, the complications progressed to more severe stages, despite a clear trend toward better BGC. This may be suggestive of the negative metabolic memory phenomenon, which necessitates stable BGC, starting at the onset of the disease, for the prevention of microvascular complications.
Известно, что во время беременности у женщин развивается физиологическая инсулинорезистентность, которая сама по себе является фактором риска нарушений углеводного обмена. Ранняя диагностика гипергликемии у женщин, входящих в группы риска по диабету, в начале беременности, и ее планирование для женщин с уже диагностированным сахарным диабетом (СД) до наступления беременности являются профилактикой осложнений беременности и родов. Самоконтроль глюкозы в крови для таких пациенток является неотъемлемой частью рекомендаций по их наблюдению. Достижение нормогликемии в течение всего периода гестации обусловливает прогнозирование перинатальных исходов: снижение процента развития макросомии, тяжелых форм диабетической фетопатии плода, увеличивает процент естественных родов. Использование портативных глюкометров для ежедневного контроля глюкозы в крови определяет выбор терапии для лечения беременных с различными нарушениями углеводного обмена.
L.L. BOLOTSKAYA, PhD in medicine, I.N. ULYANOVA, PhD in medicine, L.V. SAVELYEVA, PhD in medicine National Medical Research Center of Endocrinology of the Ministry of Health of Russia USE OF NEW TECHNOLOGIES FOR THE MANAGEMENT OF GLYCEMIA IN PATIENTS WITH VARIOUS CARBOHYDRATE METABOLISM DISORDERS DURING PREGNANCYIt has been established that during pregnancy women may develop physiological resistance to the action of insulin, which in itself is a risk factor for carbohydrate metabolism disorders. Early diagnosis of hyperglycemia in women at risk for diabetes at the beginning of pregnancy and in women with diagnosed diabetes before pregnancy at the planning stage may prevent pregnancy and childbirth complications. Self-monitoring of blood glucose for such patients is an integral part of the guidelines on follow-up of such women. The achievement of normoglycemia throughout the gestation period makes it possible to forecast perinatal outcomes such as reduced rates of development of macrosomia, severe degrees of diabetic fetopathy, and an increased rates of natural births. The use of modern technologies for the management of glycemia during pregnancy, namely portable glucometers for daily monitoring of blood glucose, determines the choice of therapy for women with various carbohydrate metabolism disorders during pregnancy.
Introduction. The results of a 25-year observational program to assess the effect of glycated hemoglobin variability on the development of microvascular complications in patients with type 1 diabetes mellitus are presented.Objective: This study aimed to evaluate the effect of glycated hemoglobin (HbA1c) variability on the development of microvascular complications in patients with type 1 diabetes mellitus (DM1) and disease duration of 25 years.Materials and methods: A retrospective analysis of the database of patients with DM1 was performed from the moment of the disease manifestation until the time of the last visit. Determination of HbA1c level is carried out using parameters certified in accordance with the National Standard for Glycohemoglobin Standardization (NGSP) or the International Federation of Clinical Chemists (IFCC). HbA1c variability was determinated by average current HbA1c, average of longitudinal HbA1c (from the manifestation to the last visit – 2019), median and maximum of difference in changes of HbA1c (median and max∆HbA1c). Statistical analysis was performed by IBM SPSS Statistics ver.22. A statistically significant difference is the value p < 0.05.Results. A total of 88 patients were enrolled in this study, they were divided in 3 groups depending on the registered microvascular complications (MVC): without MVC (n = 38), isolated MVC (retinopathy or nephropathy) (n = 25) and multiple MVC (retinopathy and nephropathy) (n = 25). Clinical characteristics [median (25; 75 percentile)]: age of manifestation of DM1 is 9 years (5; 12), age of patients at the time of the last visit is 33 years (29; 35), duration of DM1 is 24 years (20; 27), body mass index 24 kg/m2 (21; 25). Medication: basal-bolus insulin therapy (n = 82) or pump insulin therapy (n = 6). The average level of longitudinal HbA1c for the three groups was: 8% (7.6; 8.9), 8.5% (7.9; 8.9), 8.6% (7.8; 10), p = 0.2. Average of current (at the time of the last visit) HbA1c – 8.2% (7.2; 9.0), 8.1% (7.5; 9.0), 8.4% (7.3; 9.7), p = 0.4. Statistically significant differences were determined in the group without complications and in the group with multiple complications between the levels of maxΔ HbA1c 2.3% (1.8; 2.8) vs 4.7% (3.2; 5.6), p < 0.0001 and median Δ HbA1c 0.7% (0.6; 0.9) vs 1.4% (1; 1.7), р < 0.0001. There were no statistically significant relationships between the maximum and medianΔ HbA1c in the groups without complications and in the group with isolated complications.Conclusions: Longitudinal HbA1c and current HbA1c are not associated with the development of microvascular complications. The potential role in the development of microvascular complications was determined for the maximum and median Δ HbA1c.
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