Diabetes mellitus in Russian Federation: prevalence, morbidity, mortality, parameters of glycaemic control and structure of glucose lowering therapy according to the Federal Diabetes Register, status 2017

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 of HbA1c, evaluate the therapy in Russian Federation in 2013–2017. 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 2013→2017 per 100,000 population was as follows: T1 159,8→169,6; T2 2455.3→2775.6; other DM types 51,2→65,8. Morbidity: T1 9,8→7,0; T2 226,7→185,2; other DM types 7,8→12,4. The structure of causes of death 2013→2017: T1: diabetic coma 2,0→1,5%, myocardial infarction 4,0→4,4%, cerebral circulation disorders 8,2→7,6%, cardiovascular insufficiency 18,5→16,4%, chronic renal failure 6,1→ 6,0%; T2 0,2→0,2%, 4,5→4,5%, 12,7→12,2%, 29,0→28,6%, 1,2→1,8%, respectively. Mortality: T1 2.3; T2 68.4, other DM types 0,8. Life expectancy (average age of death of patients): T1 male 50.3→50.2, female 60.2→ 57.2; T2 69.8→70.3, 75.1→75.9 respectively. The number of patients with target HbA1c level <7%: T1 22.3→34.0%, T2 38.0→52.4%; HbA1c≥9.0%: T1 29.2→21.1%, T2 12.6→8.8%. 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

Trends in the epidemiology of chronic kidney disease in Russian Federation according to the Federal Diabetes Register (2013–2016)

BACKGROUND: Chronic kidney disease (CKD) is one of the most severe complications of diabetes mellitus (DM), this determines the importance of the study of epidemiological characteristics of the disease. AIMS: To assess the epidemiological characteristics of CKD in adult DM patients with type 1 (T1), 2 (T2) in Russian Federation in 201316. METHODS: We have used the database of the Russian Federal Diabetes register, 81st regions included in online register. Indicators were estimated per 10,000 adult DM patients (18years). RESULTS: In 2016, the CKD frequency registration was T1 23%, T2 6.9% with marked interregional differences 1.5-49.9%, 0.623.5%, respectively. The CKD prevalence in dynamics 20132016 was 2171.42303.0 in T1 and 512.687.2 in T2. The incidence of new CKD cases increased 2 times in T1 (215.5 vs 104.2), and 3.7 times in T2 (190.4 vs 51.8). The analysis of distribution by CKD stages by KDIGO indicates the increase in the proportion of patients with low and moderate cardiovascular risk and end stage renal disease (ESRD) (with the initial stages of CKD, C1/2 A1) - 12.046.8% in T1; 10.050.4% in T2. The proportion of patients with a very high risk (stages C4/5 C3aA3 and C3bA2-3) progressively decreases: 13.46.7% in T1, 11.34.4% in T2. We observed relation between the CKD prevalence and DM duration. CKD develops in 5.1% patients if T15 years and in 48.0% if T130years; in T2 3.5% and 20.3%, respectively. The average age of CKD onset in T1 increased for 4,3yr (36,140,2), in T2 for 2,4yr (64,466,8), DM duration until CKD development increased in T1 11.814.2yr, in T2 7.68.2yr. CONCLUSIONS: There is a significant improvement in the quality of CKD diagnostics at the earlier stages, older age and a longer DM duration before CKD onset in both types while we observed the increasing trends in CKD prevalence in Russian Federation in the dynamics of 2013-2016. Advances in the management of patients with DM in recent years do not reduce the risk of CKD, but give us a delay in its development. The marked interregional differences frequency of registration of CKD might indicate some remaining problems in verification in a number of regions where the standard for mandatory assessment of albuminuria and glomerular filtration rate not implemented

Trends in the epidemiology of diabetic foot and lower limb amputations in Russian Federation according to the Federal Diabetes Register (2013–2016)

BACKGROUND: The epidemiological study of diabetic foot (DF) is very important because of high risk lower limbs amputations in patients with diabetes mellitus (DM). AIMS: The aim of the study was to evaluate the DF prevalence in adult patients with type 1 (T1) and 2 (T2) diabetes in Russian Federation for period 201316years. METHODS: We have used the database of the Russian Federal Diabetes register, 81st regions included in the online register. Indicators were estimated per 10,000 adult DM patients (18years). RESULTS: In 2016, the prevalence of DF in RF was T1 4,7%, T2 1,9%, with marked interregional differences: 0,1519,9%, 0,0710,3%, respectively. The DF prevalence in RF decreased: T1 506,3473,6, T2 214,60194,8. The incidence of new DF cases/per year was stable in adults with T1: 20,820,4/; increased in T2 13.214.2. The mean age of DF diagnosis increased by 2years for both DM types. The average DM duration of DF determine increased T1 15.419.0years, T2 7.410.1years. Proportion of DF forms: neuropathic with trophic ulcer 41.6%, neuropathic form (Charcot's foot) 17.9%, the neuroischemic 28.3%, ischemic 12.2%, in T2: 41.6%, 7,4%, 32,4%, 18,5%, respectively. The amount of new cases of amputations/per year in dynamics: T1 10,512,4, T2 9,610,9, with marked interregional differences 0.132.9% in T1, 0.04-6.0% in T2. The mean DM duration before amputation increased in T1 18.421.3years, in T2 9.19.9. The average amputation age: T1 51.7years, T2 66.2years. There was marked decrease in proportion of major amputations: T1 43,637,0%, T2 52.245.5 by redistribution in one toe amputations T14,010.0%, in T22,89.1%. CONCLUSIONS: The dynamic of new DF cases in adult patients in Russian Federation is stable at T1, in T2 tends to increase. The interregional differences in frequency of DF and amputations may be due to differences in the quality of specialized care, the lack or shortage of diabetic foot cabinets, treatment of patients with DF in general surgical practice in a number of regions, which is recognized as a less effective strategy. A positive fact that proportion of high amputations declines, DF develops in later age and longer diabetes duration, that may reflect the increasing effectiveness of preventive lower limbs in diabetes

Cord Blood Vitamin D, Total IgE, Cytokines Concentrations and Polyunsaturated Fatty Acids Spectrum in Newborns from Mothers with Atopic Dermatitis History

В настоящее время существует гипотеза врожденного нарушения метаболизма полиненасыщенных жирных кислот (ПНЖК) и витамина D, играющих роль в патогенезе атопического дерматита (АД). C другой стороны, наличие признаков атопии у матери рассматривается как важнейший предиктор формирования аллергических болезней у ребенка. Однако влияет ли этот фактор на баланс Th1/Th2 лимфоцитов, концентрацию витамина D и спектр ПНЖК уже к моменту рождения ребенка? С помощью проточной цитофлюориметрии и ИФА нами изучены концентрации IFN , IL-1 , IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF , TNF , IL-13, IL-18, IP-10, общего IgE и витамина D в пуповинной крови новорожденных. Кроме от матерей с наличием АД были снижены концентрации IL-13, IL-18 в пуповинной крови и процентное содержание гамма-линоленовой кислоты (ГЛК). Таким образом, наличие в анамнезе у матери новорожденного АД влияет на продукцию IL-13, IL-18 и ГЛК уже к моменту рождения ребенка, что высоковероятно свидетельствует о генетической природе найденных изменений и может быть использовано в качестве ранних маркеров предрасположенности к формированию АД. того, у этих же новорожденных исследован спектр ПНЖК эритроцитов пуповинной крови (определение методом масс-спектрометрии). Включенные в обследование новорожденные были разделены на две группы - с отсутствием (n=29) и наличием (n=19) анамнестических указаний на наличие клинических проявлений АД у их матерей. Выявлено, что у новорожденныхAt the present time there is a hypothesis on the presence of congenital polyunsaturated fatty acids (PUA) and vitamin D metabolism disturbance, which plays its role in the pathogenesis of atopic dermatitis (AD). On the other hand, the maternal atopy may be considered as one of the important predictor for allergic diseases in children. However, does this factor influence on Th1/Th2 balance forming, cord blood vitamin D and PUA concentrations already on the moment of infants birth? We used flow cytometry and ELISE techniques to study IFN , IL-1 , IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF , TNF , IL-13, IL-18, IP-10, total IgE, vitamin D cord blood concentrations and mass spectrometry method to study the content of PUA in cord blood erythrocytes. These markers were studied in two newborns groups: the 1-st one is newborns from mothers without AD history (n=29) and 2-nd one is newborns from mothers with AD history (n=19). Statistical analysis was performed using the Mann-Whitney U-test. In neonates from mothers with presence AD history we found decreasing of IL-13, IL-18 cord blood concentrations and gamma-linolenic (GLA) acid percentage in cord blood erythrocytes. Thus, maternal history of AD may influence on IL-13, IL-18 and GLA production already on the moment of infant's birth which suggests genetic background and may be used as the early markers of AD predisposition

Cord Blood Vitamin D, Total IgE, Cytokines Concentrations and Polyunsaturated Fatty Acids Spectrum in Newborns from Mothers with Atopic Dermatitis History

В настоящее время существует гипотеза врожденного нарушения метаболизма полиненасыщенных жирных кислот (ПНЖК) и витамина D, играющих роль в патогенезе атопического дерматита (АД). C другой стороны, наличие признаков атопии у матери рассматривается как важнейший предиктор формирования аллергических болезней у ребенка. Однако влияет ли этот фактор на баланс Th1/Th2 лимфоцитов, концентрацию витамина D и спектр ПНЖК уже к моменту рождения ребенка? С помощью проточной цитофлюориметрии и ИФА нами изучены концентрации IFN , IL-1 , IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF , TNF , IL-13, IL-18, IP-10, общего IgE и витамина D в пуповинной крови новорожденных. Кроме от матерей с наличием АД были снижены концентрации IL-13, IL-18 в пуповинной крови и процентное содержание гамма-линоленовой кислоты (ГЛК). Таким образом, наличие в анамнезе у матери новорожденного АД влияет на продукцию IL-13, IL-18 и ГЛК уже к моменту рождения ребенка, что высоковероятно свидетельствует о генетической природе найденных изменений и может быть использовано в качестве ранних маркеров предрасположенности к формированию АД. того, у этих же новорожденных исследован спектр ПНЖК эритроцитов пуповинной крови (определение методом масс-спектрометрии). Включенные в обследование новорожденные были разделены на две группы - с отсутствием (n=29) и наличием (n=19) анамнестических указаний на наличие клинических проявлений АД у их матерей. Выявлено, что у новорожденныхAt the present time there is a hypothesis on the presence of congenital polyunsaturated fatty acids (PUA) and vitamin D metabolism disturbance, which plays its role in the pathogenesis of atopic dermatitis (AD). On the other hand, the maternal atopy may be considered as one of the important predictor for allergic diseases in children. However, does this factor influence on Th1/Th2 balance forming, cord blood vitamin D and PUA concentrations already on the moment of infants birth? We used flow cytometry and ELISE techniques to study IFN , IL-1 , IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, TNF , TNF , IL-13, IL-18, IP-10, total IgE, vitamin D cord blood concentrations and mass spectrometry method to study the content of PUA in cord blood erythrocytes. These markers were studied in two newborns groups: the 1-st one is newborns from mothers without AD history (n=29) and 2-nd one is newborns from mothers with AD history (n=19). Statistical analysis was performed using the Mann-Whitney U-test. In neonates from mothers with presence AD history we found decreasing of IL-13, IL-18 cord blood concentrations and gamma-linolenic (GLA) acid percentage in cord blood erythrocytes. Thus, maternal history of AD may influence on IL-13, IL-18 and GLA production already on the moment of infant's birth which suggests genetic background and may be used as the early markers of AD predisposition