RU2482485C2 - Diagnostic technique for achieving decompensated type 2 diabetes mellitus - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: postprandial capillary blood plasma glucose and CIRS comorbidity are determined. A prognostic index of the rehabilitation effectiveness (PIRE) is calculated given the type 2 diabetes length and the patient's age. If PIRE ≥ 0.5, the achieved target values of glycemic compensated diabetes during the resort stage of rehabilitation is predicted in more than a half of the cases. If PIRE < 0.5, the achieved target values of glycemic compensated diabetes during the resort stage of rehabilitation is predicted in less than a half of the cases.

EFFECT: method enables higher effectiveness of the resort rehabilitation of the patients suffering type 2 diabetes mellitus.

3 ex, 2 dwg

Description

The invention relates to medicine and can be used in endocrinology, restorative medicine and therapy (internal diseases).

A known method for predicting the development of type 2 diabetes mellitus (DM 2) in patients with metabolic syndrome (patent RU No. 2264170, IPC 7 A61B 10/00, G01N 33/02, published November 20, 2005), in which the metabolic dyslipidemia coefficient and anthropometric coefficient are calculated.

This method allows to predict the development of type 2 diabetes in patients with metabolic syndrome, but it is not applicable to predict the achievement of compensation for type 2 diabetes.

A known method for assessing glycemic control in diabetes according to self-control (patent application RU 2006125153, IPC G01N 33/50), taken as a prototype.

The method consists in a computerized method for estimating glycated hemoglobin (HbA _1c ) based on blood glucose data collected over a given time. With HbA _1c values in a patient suffering from T2DM, less than 7.8% indicate sufficient compensation for T2DM.

This method allows you to calculate the values of HbA _1c in patients with type 2 diabetes, however, it is not applicable to predict the achievement of compensation in patients with type 2 diabetes with glycemia, it does not take into account the effect of concomitant diseases and the duration of type 2 disease, which reduces the accuracy of the prognosis. In addition, this method requires complex calculations, while predicting the results is designed for a long period.

The objective of the claimed invention is the creation of an accurate and simple method for predicting the achievement of compensation for type 2 diabetes with glycemia in the near future in patients at the sanatorium stage of rehabilitation.

The problem is achieved in that according to the method for predicting the achievement of compensation for type 2 diabetes mellitus, including the determination of fasting capillary blood plasma glucose and the subsequent calculation of the prognostic coefficient, the duration of diabetes 2, the level of comorbidity, the age of the patient is additionally determined, and the prognostic coefficient is calculated by the formula

PIER = 15.36 + 0.068 × A-0.202 × B-0.107 × C-0.533 × D + 0.005545 × D ² -0.0073 × A × C,

where: PIER - prognostic index of the effectiveness of rehabilitation of patients with type 2 diabetes,

A is the prescription of the disease of diabetes 2 (from the time of diagnosis, in years),

B is the level of comorbidity (in points) calculated according to the CIRS scale,

C - the level of fasting glucose in the plasma of capillary blood (mmol / l),

D - age of the patient (in years),

and with PIER values ≥0.5, it is forecasted to achieve the target values of compensation indicators for DM 2 for glycemia during the sanatorium rehabilitation phase in most cases, when PIER values from -0.5 to 0.5, it is predicted to achieve the target values of compensation indicators for DM 2 for glycemia in the process of the sanatorium rehabilitation stage in less than half of cases, with PIER values ≤-0.5, it is forecasted to achieve the target values of compensation indicators for DM 2 for glycemia at the sanatorium stage of rehabilitation in a small number of cases.

Using this method, the accuracy of the forecast for achieving compensation in patients with type 2 diabetes who are at the sanatorium rehabilitation stage is increased, the forecast is calculated for a short period of three weeks. The method is simple to implement, available to doctors, does not require large material costs.

The claimed method is carried out as follows: the American Diabetes Association recommendations [ADA, 2010, see Appendix 1] were chosen as the target values for compensating for diabetes mellitus 2 for glycemia, where the fasting plasma glucose level of capillary blood was recommended to be less than the target value for treatment of diabetes mellitus (compensation indicator) 7.2 mmol / L.

Predicting the achievement of diabetes compensation in patients with type 2 diabetes by glycemia at the sanatorium stage of rehabilitation is done by determining the patient's age (in years), the duration of type 2 diabetes (since diagnosis, in years), determining the level of glucose in the blood plasma of capillary blood (in mmol / l) on an empty stomach in the morning, not earlier than 8 hours after the last meal, by any standard method (but not using a glucometer) on the second or third day from the beginning of sanatorium rehabilitation, as well as determining the level of comorbidity in points, which odschityvaetsya on cumulative disease rating scale (Cumulative Illness Rating Scale (CIRS), see. Appendix 2).

The invention is illustrated by the following examples of specific performance.

Example 1. Patient I., 52 years old. Clinical diagnosis: type 2 diabetes mellitus, first detected, moderate, subcompensation. Diabetic angiopathy of the retinal vessels. Common osteoarthrosis of the spine without exacerbation. Chronic prostatitis without exacerbation. The duration of the disease is 0.1 years (from the moment of diagnosis). Arrived at the sanatorium stage of rehabilitation after treatment in a hospital. Received a hypoglycemic diabetes mellitus therapy 240 mg per day. The level of comorbidity calculated by CIRS was 11 points. The value of fasting glucose at the beginning of treatment was 6.7 mmol / L.

PIER = 15.36 + 0.068 × 0.1-0.202 × 11-0.107 × 6.7-0.0533 × 52 + 0.005545 × 52 × 52-0.0073 × 0.1 × 6.7 = -0 , 31

According to the PIER value of -0.31, the patient was assigned to the group where the probability of achieving compensation for DM 2 by glycemia is less than half the cases.

After the course of sanatorium rehabilitation, which included the intake of mineral water, diet therapy, exercise therapy, health path, physiotherapy, mechanical massage, drug therapy, the value of fasting glycemia was 7.6 mmol / l at the end of treatment (target value less than 7.2 mmol / l), the value of postprandial (two hours after eating) glycemia was 7.6 mmol / l (target value less than 10 mmol / l). The value of the sugar in the urine at the end of treatment was 2% (with admission 0.5%). The resulting indicators indicate the correctness of predicting the possibility of compensation for type 2 diabetes by glycemia using PIER.

Example 2. Patient S., 54 years old. Clinical diagnosis: type 2 diabetes mellitus, moderate, compensation. Diabetic sensorimotor polyneuropathy of the 1st stage. Obesity of 1 degree (WHO). Arterial hypertension 2 tbsp., Risk 4, CHF 1.

The disease is 1 year old (from the moment of diagnosis). Arrived at the sanatorium stage of rehabilitation after treatment in a hospital. He received glucose-lowering therapy with glucophage 2000 mg per day.

The comorbidity level calculated by CIRS was 8 points. The value of fasting glucose at the beginning of treatment was 4.7 mmol / L.

PIER = 15.36 + 0.068 × 1-0.202 × 8-0.107 × 4.7-0.0533 × 54 + 0.005545 × 54 × 54-0.0073 × 1 × 4.7 = 0.65

According to the PIER value of 0.65, the patient was assigned to the group where the probability of achieving compensation for DM 2 by glycemia is possible in most cases.

After a course of sanatorium rehabilitation, including the intake of mineral water, diet therapy, exercise therapy, health path, physiotherapy, mechanical massage, drug therapy, the value of fasting glycemia was 4.3 mmol / l at the end of treatment (target value less than 7.2 mmol / l), the value of postprandial (two hours after eating) glycemia was 5.6 mmol / l (target value less than 10 mmol / l). Sugar in urine is not detected. The resulting indicators indicate the correctness of predicting the possibility of compensation for type 2 diabetes by glycemia using PIER.

Example 3. Patient G., 61 years old. Clinical diagnosis: type 2 diabetes mellitus, moderate, insulin-consuming, subcompensation. Diabetic non-proliferative angioretinopathy. Diabetic sensorimotor polyneuropathy of the 1st stage. Arterial hypertension 2 tbsp., Risk 4, CHF 1. Chronic viral hepatitis C, remission. Urolithiasis disease. Chronic prostatitis, remission.

The disease is 5 years old (from the moment of diagnosis). Arrived at the sanatorium stage of rehabilitation after treatment in a hospital. Received a hypoglycemic therapy with protafan 20 units / day and actrapid 16 units / day. The comorbidity level calculated by CIRS was 15 points. The value of fasting glucose at the beginning of treatment was 10.6 mmol / L.

PIER = 15.36 + 0.068 × 5-0.202 × 15-0.107 × 10.6-0.0533 × 61 + 0.005545 × 61 × 61-0.0073 × 5 × 10.6 = -0.75

According to the PIER value of -0.75, the patient was assigned to the group where the likelihood of achieving compensation for DM 2 by glycemia is unlikely.

After the course of sanatorium rehabilitation, which included the intake of mineral water, diet therapy, exercise therapy, health path, physiotherapy, mechanical massage, drug therapy, the value of fasting glycemia was 8.4 mmol / l at the end of treatment (target value less than 7.2 mmol / l) , the value of postprandial glycemia (two hours after eating) was 10.0 mmol / L (target value less than 10 mmol / L). The resulting indicators indicate the correctness of predicting the possibility of compensation for type 2 diabetes by glycemia using PIER.

Claims (1)

A method for predicting the achievement of compensation for type 2 diabetes mellitus at the sanatorium stage of the rehabilitation phase, including the determination of fasting glucose in capillary blood plasma and the subsequent calculation of the prognostic coefficient, characterized in that it additionally determines the duration of diabetes 2, the level of comorbidity, the patient's age and calculate the prognostic coefficient according to the formula
PIER = 15.36 + 0.068 · A-0.202 · B-0.107 · C-0.533 · D + 0.005545 · D ² -0.0073 · A · C,
where PIER is a prognostic index of the effectiveness of rehabilitation of patients with type 2 diabetes,
A - the duration of diabetes 2 (from the time of diagnosis, in years), B - the level of comorbidity (in points), calculated according to the CIRS scale,
C - the level of fasting glucose in the plasma of capillary blood (mmol / l),
D is the age of the patient (in years),
and with PIER values ≥0.5, it is forecasted to achieve the target values of compensation indicators for DM 2 for glycemia at the stage of the sanatorium rehabilitation stage in more than half of cases, when PIER values <0.5, it is forecasted to achieve the target values of compensation indicators for DM 2 for glycemia at the stage of the sanatorium stage rehabilitation in less than half of cases.

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