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)


DOI: https://dx.doi.org/10.18565/therapy.2024.9.7-14

Lukina Yu.V., Zagrebelny A.V., Kutishenko N.P., Voronina V.P., Martsevich S.Yu., Shepel R.N., Drapkina O.M.

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia, Moscow
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%).
Keywords: drug prophylaxis, absence of glycemic disorders, pre-diabetes, impaired glucose tolerance, diagnostics, metformin, diabetes mellitus
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About the Autors

Yulia V. Lukina, MD, Dr. Sci. (Medicine), leading researcher at the Laboratory of pharmacoepidemiological research of the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: yuvlu@mail.ru
ORCID: https://orcid.org/0000-0001-8252-3099
Alexander V. Zagrebelny, MD, PhD (Medicine), senior researcher at the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: azagrebelny@mail.ru
ORCID: https://orcid.org/0000-0003-1493-4544
Natalya P. Kutishenko, MD, Dr. Sci. (Medicine), head of the Laboratory of pharmacoepidemiological research of the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: nkutishenko@gnicpm.ru
ORCID: https://orcid.org/0000-0001-6395-2584
Victoria P. Voronina, MD, PhD (Medicine), senior researcher at the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: vvoronina@gnicpm.ru
ORCID: https://orcid.org/0000-0001-5603-7038
Sergey Yu. Martsevich, MD, Dr. Sci. (Medicine), professor, head of the Department of preventive pharmacotherapy, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: sergeymartsevich@mail.ru
ORCID: https://orcid.org/0000-0002-7717-4362
Ruslan N. Shepel, MD, PhD (Medicine), deputy director for prospective development of medical activities, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: RShepel@gnicpm.ru
ORCID: https://orcid.org/0000-0002-8984-9056
Oksana M. Drapkina, MD, Dr. Sci. (Medicine), professor, academician of RAS, director of National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101990, Moscow, 10/3 Petroverigsky Lane.
E-mail: ODrapkina@gnicpm.ru
ORCID: https://orcid.org/0000-0002-4453-8430


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