Самоконтроль как одна из важнейших опций в предотвращении осложнений у пациентов с сахарным диабетом

Мануйлова Ю.А. Самоконтроль как одна из важнейших опций в предотвращении осложнений у пациентов с сахарным диабетом. Справочник поликлинического врача. 2018; 4: 47-51

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Manuylova Yu.A. Self-monitoring as one of the most important options in preventing complications in patients with diabetes mellitus. Handbook for Practitioners Doctors. 2018; 4: 47-51

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Аннотация

Сахарный диабет является одной из наиболее значимых проблем в медицине. Смертность от осложнений сахарного диабета крайне велика. Основным способом предотвращения возникновения поздних осложнений является поддержание удовлетворительного гликемического контроля. Необходимым условием этого остается самоконтроль глюкозы, осуществляемый с помощью глюкометра. Компенсация сахарного диабета зависит от частоты самоконтроля, однако не всегда пациенты проводят его в соответствии с рекомендациями своего врача. Помимо экономических причин (недостаточность обеспечения тест-полосками и относительно высокая их стоимость) неадекватная частота самоконтроля связана с плохим обучением пациентов: нет понимания целей самоконтроля, возможности корректировать терапию, диету и физическую активность в соответствии с полученными результатами анализа. Вот почему очень важны две составляющие самоконтроля: точность и простота в использовании глюкометра, а также обязательное обучение пациента принципам, целям самоконтроля и алгоритму действий при получении того или иного результата измерения гликемии.

Ключевые слова: сахарный диабет, частота самоконтроля гликемии, осложнения сахарного диабета, качество жизни, обучение пациентов.

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Diabetes is one of the most significant problems in modern medicine. Mortality from complications of diabetes is extremely high. The main way to prevent the occurrence of late complications is to maintain satisfactory glycemic control. A necessary condition for this remains the self-control of glucose, carried out with the help of a glucometer. Compensation of diabetes depends on the frequency of self-control, but patients do not always conduct it in accordance with the recommendations of their respective doctor. In addition to economic reasons (insufficient provision of test strips and relatively high cost), the inadequate frequency of self-monitoring is associated with poor patient education: there is no understanding of self-monitoring goals, the ability to adjust therapy, diet and physical activity in accordance with the results of the analysis. That is why two components of self-control are very important: the accuracy and ease of use of the glucometer, as well as the obligatory teaching of the patient to the principles, goals of self-control and the algorithm of actions in obtaining a certain result of the measurement of glycemia.

Key words: diabetes mellitus, frequency of self-control of glycemia, complications of diabetes mellitus, quality of life, patient education.

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Список литературы

1. Дедов И.И., Шестакова М.В., Викулова О.К. Эпидемиология диабета в Российской Федерации: клинико-статистический анализ по данным Федерального регистра сахарного диабета. Сахарный диабет. 2017; 20 (1): 13–41. / Dedov I.I., Shestakova M.V., Vikulova O.K. Epidemiologiya diabeta v Rossijskoj Federacii: kliniko-statisticheskij analiz po dannym Federal'nogo registra saharnogo diabeta. Saharnyj diabet. 2017; 20 (1): 13–41. [in Russian]
2. García de la Torre N, Durán A, Del Valle L et al. Early management of type 2 diabetes based on a SMBG strategy: the way to diabetes regression – the St Carlos study: a 3-year, prospective, randomized, clinic-based, interventional study with parallel groups. Acta Diabetol 2013; 50: 607–14.
3. Schütt M, Kern W, Krause U et al. Is the frequency of self-monitoring of blood glucose related to long-term metabolic control? Multicenter analysis including 24.500 patients from 191 centers in Germany and Austria. Exp Clin Endocrinol Diabetes 2006; 114 (7): 384–8.
4. Joo EY, Lee JE et al. Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes. Diabetes Metab J 2018 Jun 29.
5. Ziegler R, Heidtmann B, Hilgard D et al. Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12 (1): 11–7.
6. Franciosi M, Pellegrini F, De Berardis G et al. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care 2001; 24 (11): 1870–7.
7. Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev 2012; 1.
8. Machry RV, Rados DV, Gregório GR, Rodrigues TC. Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis. Diabetes Res Clin Pract 2018; 142: 173–87.
9. Kan K, Zhu W, Lu F et al. Contribution of Structured Self-Monitoring of Blood Glucose to the Glycemic Control and the Quality of Life in Both Insulin- and Noninsulin-Treated Patients with Poorly Controlled Diabetes. Diabetes Technol Ther 2017; 19 (12): 707–14.
10. Harashima S, Nishimura A, Ikeda K et al. Once Daily Self-Monitoring of Blood Glucose (SMBG) Improves Glycemic Control in Oral Hypoglycemic Agents (OHA)-Treated Diabetes: SMBG-OHA Follow-Up Study. J Diabetes Sci Technol 2015; 10 (2): 378–82.
11. International Diabetes Federation. IDF guideline on self-monitoring of blood glucose in non-insulin treated type 2 diabetes. www.hse.ie/yourmedicines
12. Ji L, Su Q, Feng B et al. Structured self-monitoring of blood glucose regimens improve glycemic control in poorly controlled Chinese patients on insulin therapy: Results from COMPASS. J Diabetes 2017; 9 (5): 495–501.
13. Nishimura A, Harashima S, Honda I et al. Color record in self-monitoring of blood glucose improves glycemic control by better self-management. Diabetes Technol Ther 2014; 16 (7): 447–53.
14. Nishimura A, Harashima SI, Hosoda K, Inagaki N. Long-Term Effect of the Color Record Method in Self-Monitoring of Blood Glucose on Metabolic Parameters in Type 2 Diabetes: A 2-Year Follow-up of the Color IMPACT Study. Diabetes Ther 2018; 9 (4): 1501–10.
15. Grady M, Katz LB, Levy BL. Use of Blood Glucose Meters Featuring Color Range Indicators Improves Glycemic Control in Patients With Diabetes in Comparison to Blood Glucose Meters Without Color (ACCENTS Study). J Diabetes Sci Technol 2018 May 1.
16. Caswell M et al Оценка точности и эффективности системы контроля уровня глюкозы крови. Diabetes Technol Ther 2015; 17 (3): 1–6.

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1. Dedov I.I., Shestakova M.V., Vikulova O.K. Epidemiologiya diabeta v Rossijskoj Federacii: kliniko-statisticheskij analiz po dannym Federal'nogo registra saharnogo diabeta. Saharnyj diabet. 2017; 20 (1): 13–41. [in Russian]
2. García de la Torre N, Durán A, Del Valle L et al. Early management of type 2 diabetes based on a SMBG strategy: the way to diabetes regression – the St Carlos study: a 3-year, prospective, randomized, clinic-based, interventional study with parallel groups. Acta Diabetol 2013; 50: 607–14.
3. Schütt M, Kern W, Krause U et al. Is the frequency of self-monitoring of blood glucose related to long-term metabolic control? Multicenter analysis including 24.500 patients from 191 centers in Germany and Austria. Exp Clin Endocrinol Diabetes 2006; 114 (7): 384–8.
4. Joo EY, Lee JE et al. Frequency of Self-Monitoring of Blood Glucose during the School Day Is Associated with the Optimal Glycemic Control among Korean Adolescents with Type 1 Diabetes. Diabetes Metab J 2018 Jun 29.
5. Ziegler R, Heidtmann B, Hilgard D et al. Frequency of SMBG correlates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12 (1): 11–7.
6. Franciosi M, Pellegrini F, De Berardis G et al. The impact of blood glucose self-monitoring on metabolic control and quality of life in type 2 diabetic patients: an urgent need for better educational strategies. Diabetes Care 2001; 24 (11): 1870–7.
7. Malanda UL, Welschen LM, Riphagen II, Dekker JM, Nijpels G, Bot SD. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Cochrane Database Syst Rev 2012; 1.
8. Machry RV, Rados DV, Gregório GR, Rodrigues TC. Self-monitoring blood glucose improves glycemic control in type 2 diabetes without intensive treatment: A systematic review and meta-analysis. Diabetes Res Clin Pract 2018; 142: 173–87.
9. Kan K, Zhu W, Lu F et al. Contribution of Structured Self-Monitoring of Blood Glucose to the Glycemic Control and the Quality of Life in Both Insulin- and Noninsulin-Treated Patients with Poorly Controlled Diabetes. Diabetes Technol Ther 2017; 19 (12): 707–14.
10. Harashima S, Nishimura A, Ikeda K et al. Once Daily Self-Monitoring of Blood Glucose (SMBG) Improves Glycemic Control in Oral Hypoglycemic Agents (OHA)-Treated Diabetes: SMBG-OHA Follow-Up Study. J Diabetes Sci Technol 2015; 10 (2): 378–82.
11. International Diabetes Federation. IDF guideline on self-monitoring of blood glucose in non-insulin treated type 2 diabetes. www.hse.ie/yourmedicines
12. Ji L, Su Q, Feng B et al. Structured self-monitoring of blood glucose regimens improve glycemic control in poorly controlled Chinese patients on insulin therapy: Results from COMPASS. J Diabetes 2017; 9 (5): 495–501.
13. Nishimura A, Harashima S, Honda I et al. Color record in self-monitoring of blood glucose improves glycemic control by better self-management. Diabetes Technol Ther 2014; 16 (7): 447–53.
14. Nishimura A, Harashima SI, Hosoda K, Inagaki N. Long-Term Effect of the Color Record Method in Self-Monitoring of Blood Glucose on Metabolic Parameters in Type 2 Diabetes: A 2-Year Follow-up of the Color IMPACT Study. Diabetes Ther 2018; 9 (4): 1501–10.
15. Grady M, Katz LB, Levy BL. Use of Blood Glucose Meters Featuring Color Range Indicators Improves Glycemic Control in Patients With Diabetes in Comparison to Blood Glucose Meters Without Color (ACCENTS Study). J Diabetes Sci Technol 2018 May 1.
16. Caswell M et al Оценка точности и эффективности системы контроля уровня глюкозы крови. Diabetes Technol Ther 2015; 17 (3): 1–6.

Авторы

Ю.А.Мануйлова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М.Сеченова» Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
juliakolish@yahoo.com

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Yu.A.Manuylova

I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
juliakolish@yahoo.com

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