[Implementation of the calculator of individual goals of therapeutic control of diabetes mellitus in the practice of providing medical care to elderly patients.]

Abstract

Objective - to evaluate the experience of implementing a digital clinical calculator for individual clinical and metabolic control goals in routine outpatient medical care for elderly patients with type 2 diabetes mellitus (DM2). A cross-sectional observational sample study was performed in a sample of elderly patients with DM2 who sought routine medical care at an outpatient medical organization (n=77); participants were examined according to the standard protocol of outpatient follow-up of an elderly patient with DM2, including 124 clinical and laboratory indicators; a developed digital calculator was used to assess individual therapeutic control goals The frequency of achieving treatment goals and the structure of drug therapy are determined. A high incidence of atherogenic pathology was confirmed: coronary heart disease (41,6%), chronic heart failure (27,3%), hypertension (62,3%), obesity (50,6%), dyslipidemia (46,8%), exceeding population values; an imbalance in achieving therapeutic goals was revealed: indicators glycemic control levels are close to optimal values (HbA1c 7,5±1,5%), while LDL exceeds the target level by 2 times (3,1±0,9 mmol/l); 88% of participants do not achieve the goal of lipidemic control calculated according to regulatory criteria; biguanides predominate in the structure of drug therapy (55,8%). For elderly patients with DM2, diseases associated with increased cardiovascular risk pose the greatest danger; insufficient detection of dyslipidemia in conditions of limited outpatient admission may be due to the complexity of the algorithm for stratifying lipid control goals; the use of digital tools allows to identify reserves for prescribing lipid-lowering and hypoglycemic therapy and optimize the trajectory of drug treatment if the target values of biomarkers of clinical and metabolic control; to focus the doctor's attention on the priority task of increasing the effectiveness of evidence-based risk management.