[Determination of the goals of therapeutic control of type 2 diabetes mellitus in elderly patients using a digital clinical calculator.]

Abstract

According to the federal register, up to 3,77 million elderly Russians have a confirmed diagnosis of type 2 diabetes mellitus (DM2), the most important criterion for the effectiveness of treatment of which is the achievement of therapeutic control targets. At the same time, the structure of the algorithm for their assessment in elderly patients is quite complex and involves the analysis of many different parameters, including indicators of geriatric status. The aim of the study was to develop a digital clinical calculator for determining individual goals of DM2 control in elderly patients based on the principles of evidence-based medicine. The methodology of their assessment is based on the clinical recommendations of the Ministry of Health of the Russian Federation on DM2 and senile asthenia, as well as taking into account the IDF guidelines. Priority attention is given to the assessment of glycemic control indicators. The Calculator matrix allows you to determine 5 response variables: the target range of HbA1c, target LDL and blood pressure levels, the number of risk factors for ASD and the category of functional dependence of an elderly person. The last parameter can be calculated automatically based on the results of processing information entered into the corresponding modules of the Calculator: the questionnaire block «Age is not a hindrance»; an original algorithm for screening for probable sarcopenia according to objective clinical criteria; windows for entering scores on the Bartel, Lawton and Mini-Cog scales. An analysis of the features of the therapeutic management of elderly patients with DM2 and clinical experience in the application of the Calculator led to the conclusion that it is necessary to limit the lower limit of the target range of HbA1c values for people over the age of 60 years, with an emphasis on a digital methodology for weighted risk assessment and the potential benefits of intensifying treatment of DM2, taking into account geriatric status; the results are stored in digital format, which allows you to use They are used for CGO and monitoring the effectiveness of the treatment.