Professor of Medicine, RUDN University
Title: The level of comorbidity and individualized choice of the goals of therapy for HB1Ac
Irina Kurnikova - MD, PhD, Professor of Medicine, RUDN University (Peoples Friendship University of Russia), Moscow, Russia. She has extensive experience in the field of scientific and practical Endocrinilogy. Dealing with Problems of Endocrinology more than 20 years. The main areas of her research are the optimization of the system approach to the treatment and rehabilitation of patients with diabetes mellitus, diseases of the thyroid gland, disturbances in the system of regulation of the organism and other endogenous factors (comorbidity, interstitial humoral transport et al.). Currently teaches at Peoples' Friendship University of Russia, curator of the scientific direction of endocrinology. Has published more than 20 articles in well-known journals, the author of 25 books and manuals in Russian, 10 patents for inventions.
Statement of the Problem: the "complexity category" of patient management increases many times, if the somatic disease had combined with multi-organ systemic disease, such as diabetes mellitus (type 1 diabetes - DT1 and type 2 diabetes - DT2). Simultaneous formation of several diseases in a patient: arterial hypertension, atherosclerosis, ischemic heart disease and diabetes mellitus, creates not only significant difficulties in diagnosis, but affects the quality of care and worsens the prognosis. The purpose of this study is to study the influence of somatic pathology on the level of glycemic control indices of patients with diabetes mellitus from the viewpoint of cause-effect relationships and mechanisms of polymorphic formation. Methodology & Theoretical Orientation: A special complex examination of patients was conducted. The control of carbohydrate metabolism was provided in accordance with the recommendations of WHO by repeatedly examining the glycemic profile and glycated hemoglobin (HbA1c). The comorbidity was assessed according to the CIRS - Cumulative Illness Rating Scale. Findings: in our study, the risk of developing concomitant cardiovascular disease had a positive association with DT 2 (RR = 3.4, p <0.001), and the chances of developing a cardiovascular pathology in DT 2 were significantly higher (OR = 15.7; X² = 151.6). The multiplicity of complications was significant in patients with DT1 (RR = 1.96, p = 0.095) and 3 times increased the risk of cardiovascular disease (OR = 3.47, p = 0.008), but for DT2 this criterion had a weak negative association for RR (RR = 0.86, p <0.001) and influenced the increase in odds (OR = 0.39; p = 0.03). The duration of the course of DT1 for more than 10 years contributed to an increase in the relative risk and odds ratio (RR = 3.43, p <0.001, OR = 8.29, CI 95% 4.36-15.76) for pathology formation. Almost 3 times increased risk of cardiovascular disease in patients with DT2 with a BMI more than 30 (RR = 2.95, p = 0.063). The risk of cardiovascular disease in case of unsatisfactory compensation of CD1 (RR = 1.16, p = 0.021, OR = 1.27), DT2 (RR = 1.39, p <0.001, OR = 2.28). However, to assert that the risk of developing concomitant cardiovascular pathology increases the fluctuations in the level of glycemia in patients with diabetes (OR DT1 = 2.19, CI 95% 0.46-10.45, ORSD2 = 5.93 CI 95% 0.75-46, 91) with the obtained CI level of 95% is not possible. The significance of lipid metabolism disorders (atherogenicity index) in the development and progression of coronary pathology in diabetic patients was confirmed, and this factor was much more significant in patients with DT1 (OR DT1 = 11.4; OR DT2 = 30.9).Compensation of diabetes by glycemic values depended on the duration of the disease of DT 2 (r = 0.42, p <0.05), the severity of comorbidity, and corresponded to the degree of comorbidity (r = 0.67, p <0.05) in Cumulative Illness Rating Scale (CIRS). For basal glycemia, at the beginning and after treatment, the correlation coefficient (r) is 0.56 and 0.67, respectively. For postprandial glycemia - 0.45 and 0.35, respectively (p <0.05). The relationship between the values of basal glycemia and the indicators of comorbidity after the completion of the course of treatment is strengthened, and postprandial - decreases. Rates of basal glycemia reached normal values only in patients with low CIRS. At high values of CIRS (14 or more points), it was not possible to normalize the parameters of carbohydrate metabolism in the majority of patients Conclusion & Significance: somatogenic pathomorphological disturbances have a fundamental effect on the course of diabetes, which in turn is a risk factor for the development and progression of somatic pathology. The level of comorbidity should be taken into account when determining the target level of glycated hemoglobin. One of the options for a quantitative criterion can be the definition CIRS. The higher the comorbidity, the less rigid the target values of HbA1c.