Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry

Diabetes mellitus (DM) is a chronic non-infectious disease, and its prevalence has reached global epidemic [1–4]. The enormous economic costs and social damage associated with the increase in the prevalence of DM and diabetic complications, high disability rate and mortality of this disease, led to the adoption of the United Nations (UN) Resolution in 2006 that declared a worldwide threat of DM and called for the development of national programmes on prevention, treatment and prophylaxis of diabetes and its complications.

Under these conditions, the organisation of a system for recording and monitoring DM indicators became a priority for the first order of national health systems. Thus, the development of the structure of the DM registry, which is a key source of epidemiological data, assumed national significance.

In the Russian Federation, clinical and epidemiological monitoring of DM has been performed since 1996 through the State Registry of DM Patients (SRDP), which is a methodological and organisational reference centre in the Federal State Budgetary Institution Endocrinology Research Centre of the Ministry of Health of Russia [5]. The SRDP was created by the Order of the Ministry of Health of the Russian Federation No. 404 on 10 December 1996 within the framework of the Federal Target Programme ‘Diabetes Mellitus.’ Over a 20-year period, the work of the registry played a key role in assessing the prevalence of DM and diabetic complications in the Russian Federation [6]. However, until recently, data analysis was conducted statically, representing a single-step cross-section for the period of the end of the calendar year based on the summation of databases of individual subjects in the Russian Federation.

Currently, the name of the SRDP has been transformed into a single federal database with authorised online access, which does not require the transfer of databases of regional registry segments. A distinctive feature of the modern registry is the possibility of online data entry and dynamic monitoring of indicators at any level, from an individual institution to a district, region and the Russian Federation as a whole. In addition, a new format of the registry enables system control of important parameters such as regulation of updating information and the quality of the data entered, including monitoring duplicates, entry of erroneous social and demographic characteristics, and therapies that do not meet the modern standards.

The purpose of the new registry system is to increase the efficiency of work as a key scientific and analytical platform to implement organisational and management decisions for the development and improvement of diabetes care in the Russian Federation.

Materials and Methods

The focus of the study was the database of the Federal DM Registry, comprising 79 regions of the Russian Federation included in the online registry system on 31 December 2016 (Fig. 1). The total number of DM patients in the Russian Federation was calculated using data from the Federal State Statistics Service (Rosstat) [7] on the number of DM patients in six regions that do not use online registry system.

Fig. 1 Regions of the Russian Federation included in the system of the online DM registry as at 31.12.2016

Results

Analysis of prevalence of DM in the Russian Federation

The total number of DM patients in the Russian Federation (85 regions, taking into account six regions according to the Rosstat) on 31 December 2016, was 4.348 million (3% of the Russian Federation population), including: type 2 DM (T2DM) (92%; 4,001,860 people), type 1 DM (T1DM) (6%; 255,385 people), and other types of DM (2%; 75,123 people). In 16,054 patients, the type of DM was not indicated in the database (Fig. 2).

Fig. 2 Total number of DM patients according to the data of the DM registry of the Russian Federation for the period 2000–2016

Thus, there has been a stable increase in the prevalence of DM in the Russian Federation, with an increase of 569,000 patients compared with 3.779 million as at 31 December 2012 [6], and an increase of 254 thousand compared with 4094 million patients as at 01/01/2015 [8].

The prevalence rate of DM by age group is presented according to the online registry in 79 regions of the Russian Federation (Table 1). Relevant data on DM prevalence in each of the 79 regions are presented in Appendix 1, Tables 1–4, all age groups: children, adolescents and adults, respectively (published as an online application).

Table 1. Indicators of DM prevalence in different age groups in 79 regions, as at 31 December 2016

The prevalence of DM per 100,000 of the population in different age groups.

Total of all age groups:

T1DM: 164.19 per 100,000 of the population;

T2DM: 2637.17 per 100,000 of the population;

Other types of DM: 50.62 per 100,000 of the population.

There was an increase in the prevalence of DM per 100,000 of the population compared with the data from 2015: T1DM increased from 157.4 to 164.19 per 100,000 of the population, and T2DM increased from 2518.3 to 2637.17 per 100,000 of the population.

In the paediatric age group:

T1DM: 86.73 per 100,000 children;

T2DM: 5.34 per 100,000 children;

Other types of DM: 1.0 per 100,000 children.

There was an increase in the prevalence of T1DM per 100,000 children compared with the data from 2015, from 70.2 to 86.73 per 100,000 children.

In the adolescent age group:

T1DM: 203.29 per 100,000 adolescents;

T2DM: 6.82 per 100,000 adolescents;

Other types of DM: 2.62 per 100,000 adolescents.

There was an increase in the prevalence rate of T1DM per 100,000 adolescents compared with the data from 2015, from 164.1 to 203.29 per 100,000 adolescents. A high prevalence of T2DM among children and adolescents persists (5.3 and 6.8 per 100,000, respectively). This dangerous tendency may result from the high prevalence of overweight and obesity, not only in adults, but also in children and adolescents.

In the adult age group:

T1DM: 179.3 per 100,000 adults;

T2DM: 3286.6 per 100,000 adults;

Other types of DM: 62.8 per 100,000 adults.

In the adult age group, an increase in the prevalence of all types of DM was noted compared with the data from 2015: T1DM increased from 175.2 to 179.3 per 100,000 adults, T2DM increased from 3125.6 to 3286.6 per 100,000 adults, and other types of DM increased from 55.2 to 62.8 per 100,000 adults.

The dynamics of the prevalence of T1DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation (Fig. 3).

Fig. 3 Dynamics of prevalence of T1DM and T2DM from 2013–2016 in 79 regions of the Russian Federation

The primary increase in the prevalence of DM is due to T2DM, which reflects the global tendency in the increase in the proportion of T2DM among the total number of DM patients.

Despite a decrease in the dynamics of growth of T2DM in 2016 (+1.2%) compared with 2014–2015 (+4.7 and 2.8%, respectively), it is too early to regard this as a sign of a stop in the growth rate. This can be explained by the active work to identify duplicated patients in the registry database (in 2016 more than 80,000 duplicates were removed). However, the marked deterioration in the detection of new cases of T2DM in recent years is the most significant, and is confirmed by data on the reduction of the incidence rate registered (Fig. 4). Thus, the results of a large-scale National Epidemiological Study (NATION) showed that fewer than 50% of patients with T2DM are diagnosed in routine clinical practice. According to this study, the actual prevalence of T2DM in the adult population of Russia is 5.4% of the population, of which more than half (2.9%) accounts for previously unidentified T2DM that was only detected during the study (20% of the glycated hemogloblin (HbA1c) values at the time of diagnosis exceeded 9% [9]). This constitutes an extreme threat for the long-term prognosis of such patients who are not monitored by a doctor, receive no treatment, and therefore have a high risk of development of vascular complications. The NATION results again underscore the necessity to develop government programmes aimed at active screening of T2DM in the population, especially in at-risk groups.

Unlike the increase in prevalence of T2DM, the dynamics of T1DM can be regarded as having plateaued. In terms of prevalence per 100,000 of the population, the prevalence rate of T1DM in all age groups is registered, which again confirms the relative nature of this tendency.

Analysis of incidence of dm in the russian federation

The incidence rates of DM in different age groups are presented according to the online registry in 79 regions of the Russian Federation (Table 2). The indicators of the incidence of DM in each of the 79 regions of the Russian Federation are presented in Appendix 2, Table 1 (published as an online application).

Table 2. Indicators of the incidence of DM in different age groups in 79 regions, as at 12/31/2016

In 79 regions of the Russian Federation in 2016, 235,173 new cases of DM were registered: 8516 patients with T1DM (3.6%), 214,668 patients with T2DM (91.3%), and 11,989 patients with other types of DM (5.1%), In terms of morbidity per 100,000 people, this amounted to:

T1DM: 6.15 per 100,000 of the population;

T2DM: 154.9 per 100,000 of the population;

Other types of diabetes: 8.65 per 100,000 of the population.

Compared with the data of 2015, this was:

T1DM: 6.2 per 100,000 of the population;

T2DM: 152.7 per 100,000 of the population;

Other types of diabetes: 7.2 per 100,000 of the population.

There was an increase in the incidence of DM per 100,000 of the population in 2016, which was most pronounced for T2DM.

Dynamics of the incidence of T1DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation (Fig. 4).

Fig. 4 Dynamics of incidence of T1DM and T2DM from 2013–2016 in 79 regions of the Russian Federation

When evaluating indicators in dynamics, the continuing decrease in the incidence in absolute values of both T1DM and T2DM becomes evident (Fig. 4). Analysing the cause of this phenomenon does not indicate a true decrease in incidence of DM. The main reasons are the decline of active screening and detection of DM, which is typical for T2DM [9], as well as improper registration of new cases of DM in the registry database. The lack of attention to the registry management in a number of regions is reflected in the artificial lowering of the incidence of DM in the Russian Federation as a whole. This is confirmed by the considerable variability of the indicator in some regions, which cannot be explained by geographical or ethnic differences (especially in relation to T2DM).

ТThus, in 2016, the incidence of T1DM varied from 12.86 in the Republic of Karelia and 12.1 in the Republic of Tatarstan, which is two times higher than the average values in the Russian Federation, to 0 in the Republic of Tuva, Saratov Region, Nenets Autonomous Area and the Irkutsk Region, where no new cases of T1DM were registered (Appendix 2, Table 1). T2DM had a similar tendency: the incidence rates ranged from 289.8 in the Kirov region and 289.3 in the Altai Territory, which is 1.9 times higher than the average values for T2DM in the Russian Federation, to 0 in the same regions where no T1DM was registered, i.e. the Republic of Tuva, the Saratov Region, the Nenets Autonomous Area and the Irkutsk Region (Appendix 2, Table 1).

Analysis of mortality in patients with diabetes mellitus in the russian federation.

The mortality rates for DM in different age groups are presented according to the online registry in 79 regions of the Russian Federation (Table 3). The corresponding indicators for each of the 79 regions are presented in Appendix 3, Table 1 (published as an online application).

Table 3. Mortality rates for DM in different age groups in the 79 regions, as at 12/31/2016

In the 79 regions of the Russian Federation in 2016, 87,244 DM patients’ deaths were registered: 2906 T1DM patients (3.3%), 83,542 T2DM patients (95.8%), 796 patients with other types of DM (0.9%), which in terms of mortality per 100,000 people was as follows:

T1DM: 2.1 per 100,000 of the population;

T2DM: 60.29 per 100,000 of the population;

Other types of DM: 0.57 per 100,000 of the population.

The dynamics of mortality in patients with T1DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation (Fig. 5).

Fig. 5 Dynamics of mortality in patients with T1DM and T2DM in 79 regions of the Russian Federation, 2013–2016

When analysing the dynamics of indicators from 2013–2016, for the first time in the last four years, a decrease in mortality was registered for both T1DM (by 6.6%) and T2DM (by 3.6%) (Fig. 5).

The structure of mortality (Fig. 6).

Fig. 6 Structure of mortality of patients with DM in 79 regions of the Russian Federation as at 12/31/16

According to the data for 2016, cardiovascular pathology continued be the leading cause of death of patients with DM, for both types of DM. Total chronic cardiovascular insufficiency, cerebrovascular disturbances, myocardial infarction and acute cardiovascular disorders were the cause of death of 31.9% patients with T1DM and 49.5% of patients with T2DM. Unknown cause of death was excluded from the analysis (36.9% for T1DM and 29.8% for T2DM); however, the proportion of cardiovascular complications in the structure of mortality of patients with DM increased even more significantly, up to 47% for T1DM and 67% for T2DM (Figs. 7 and 8, respectively), confirming the importance of early diagnosis and therapeutic approaches aimed at correcting cardiovascular risk in DM patients. The second highest cause of death for patients with T2DM was oncological pathology (10.0%), and its share in the mortality structure continues to grow (in 2015 it was 8.42%), and for T1DM, this was terminal renal insufficiency (7.1%). In T1DM, a higher percentage of severe complications was noted, such as diabetic complications (2.7%), hypoglycaemia (1.8%), coma, sepsis (1.8%) and gangrene (1.2%), compared with T2DM (0.4%, 0.1%, 0.4%, 0.7%, respectively) which, along with the poorest indicators of carbohydrate metabolism control (Fig. 11), explains the significantly lower life expectancy values for this disease.

Fig. 7 Dynamics of established causes of death in T1DM, 2013–2016 (as at 12/31/16)

Fig. 8 The dynamics of established causes of death in T2DM, 2013–2016. (as at 12/31/16)

Analysis of life expectancy in patients with diabetes mellitus in the russian federation

Life expectancy of patients with T2DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation is shown in Figs. 9 and 10.

In the dynamics of life expectancy indicators, significant differences in patients with T1DM and T2DM were noted. For T2DM, there was a steady positive dynamic towards an increase in life expectancy in the period 2013–2016 from 69.7 to 70.1 years in men, and 74.9 to 75.5 years in women (Fig. 10), whose life expectancy exceeds the average values in the population of the Russian Federation. The life expectancy of men with T1DM can be regarded as stable with a tendency to increase from 49.6 to 50.3 years, while in women, a negative dynamic with a decrease in life expectancy from 59.4 to 58.5 years was noted over the four years (Fig. 9).

Fig. 9 Dynamics of life expectancy of patients with T1DM in 79 regions of the Russian Federation, 2013–2016

Fig. 10 Dynamics of life expectancy of patients with T2DM in 79 regions of the Russian Federation, 2013–2016

These data differ from those obtained in the period 2007–2012, indicating a significant increase in life expectancy for both T2DM and T1DM [6] that requires further analysis and interpretation. Nevertheless, it is obvious that significantly poorer indicators of carbohydrate metabolism control (77% of patients with T1DM did not reach the target HbA1c levels) and a higher mortality rate due to coma, gangrene and sepsis, which are the complications associated with unsatisfactory metabolic control, are significant factors for these negative tendencies.

Analysis of the state of carbohydrate metabolism compensation (HbA1C level)

The distribution of patients by HbA1c level in the dynamics of 2013–2016 (Fig. 11) is presented according to the online registry for 76 regions of the Russian Federation (in three regions—the Irkutsk Region, the Nenets Autonomous Area and the Republic of Tuva—the indicator was not entered in the registry, and the Saint Petersburg region was not included in the analysis due to the incomplete database in the online registry).

Fig. 11 Distribution of patients by level of HbA1c in the dynamics of 2013–2016

In the period 2013–2016 there was a persistent tendency to improve carbohydrate metabolism in both types of DM, for example, an increased number of patients with a target HbA1c level <7% to 52.1% for T2DM and 33.4% for T1DM, and a decreased number of patients with severe decompensation of DM with an HbA1c level ≥9.0%, up to 8.7% for T2DM and 22.1% for T1DM. However, the possibility of direct extrapolation of these data to the general population of DM patients in the Russian Federation is limited, since less than one-third of patients entered into the registry had HbA1c examined, that is, 32.5% with T1DM and 29.3% with T2DM.

General tendencies do not always reflect the real situation and requires targeted assessment of the dynamics in a particular region. This is confirmed by a very high variability of HbA1c, depending on the region for both T1DM (Fig. 12) and T2DM (Fig. 13).

Fig. 12 Distribution of T1DM patients according to HbA1c level, 2016

Fig. 13 Distribution of T2DM patients according to HbA1c level, 2016

Control of HbA1c requires monitoring in DM patients, both clinically, to assess the effectiveness of hypoglycaemic therapy and timely decision-making on the need for its intensification, and organisational, as a target indicator of the quality of diabetes care. For this purpose, it is necessary not only to improve the quality of HbA1c data entry into the registry (in 100% of patients), but also, first of all, to increase the availability of HbA1c measurement, regardless of the patient’s place of residence, and increase the frequency of measurement.

The frequency of measuring HbA1c level is important for DM patients, and is determined by the provision of algorithms for specialised medical care for DM patients, and is required once every 3 months [10].

Analysis of prevalence of complications

The distribution of the frequency of diabetic complications in T1DM and T2DM according to 78 regions of the Russian Federation (the region of Saint Petersburg was not included in the analysis of complications due to an incomplete online database) is shown in Fig. 14.

Fig. 14 Distribution of incidence of complications with T1DM and T2DM in 78 regions of the Russian Federation, 2016

• In T1DM, diabetic neuropathy was recorded in 33.6%, diabetic retinopathy in 27.2%, nephropathy in 20.1%, hypertension in 17.1%, diabetic macroangiopathy in 12.1%, diabetic foot syndrome in 4.3%, ischaemic heart disease (CHD) in 3.5%, cerebrovascular disorders in 1.5%, and myocardial infarction in 1.1% of patients.
• In T2DM, hypertension was most frequently recorded in 40.6%, diabetic neuropathy in 18.6%, diabetic retinopathy in 13.0%, ischaemic heart disease (CHD) in 11.0%, diabetic nephropathy in 6.3%, macroangiopathy in 6.0%, cerebrovascular disorders in 4.0%, myocardial infarction in 3.3%, and diabetic foot syndrome in 2.0% of patients.

When analysing the prevalence of diabetic complications, it was found that, according to the registry, the incidence of complications was significantly lower than according to the studies with active screening [11–12], including those obtained by examining patients in the mobile diagnostic and treatment module of the Diabetes Centre of Federal State Budgetary Institution Endocrinology Research Centre [6].

These differences are, of course, affected by the objective features of the registry’s operation, where data are recorded by appealability, i.e. only identified cases of DM and complications, which can underestimate the level of their prevalence.

Nevertheless, it is difficult to explain the significant variability in the frequency of complications by other causes, except for differences in the quality of diabetes care and insufficient attention to registry management in a number of regions.

The key factor determining the recorded incidence of complications is availability of specialised diabetes care at the primary level, namely, the presence of retinopathy rooms, treatment rooms for diabetic foot, and the availability of cardiology functional diagnostics in the region. Thus, a low incidence of complications (as good as 0% in a number of regions) may indicate an absence or inefficiency of these structures in the region, as well as non-compliance with key standards for the examination of target organs in DM patients no less than once per year and more often for at-risk groups.

This is especially important for diagnosing the initial reversible stage of complications which does not cause vivid clinical symptoms and complaints in the patient. The initial stages of diabetic complications can be effectively detected only through active appointment to specialised professionals (ophthalmologist, podiatrist) and regular performance of screening for microalbuminuria and assessment of glomerular filtration rate in all DM patients (at least once per year) [10], which is often not performed in routine clinical practice.

It should be emphasised that in many regions, in patients with T2DM, a lower incidence of not only microvascular (retinopathy, nephropathy) but also macrovascular complications was recorded, as well as diabetic foot syndrome. This cannot highlight the real situation, given the many additional factors of target organ damage in DM2, such as old age, a longer history of concomitant hypertension, dyslipidaemia, and a higher incidence of obesity. It is important to note that the actual incidence of complications in T2DM is seriously underestimated in the existing system of diabetes care [13]. Unlike patients with T1DM who are historically perceived as a high-risk cohort requiring more frequent examination, patients with T2DM often remain beyond the field of view of endocrinologists. This poses a serious threat both in terms of late diagnostics of pathology at pronounced stages, when efficiency of treatment is much lower, and in to significantly larger extent of social and economic damage, given the prevalence of patients with T2DM [14].

Since 2016, the online registry system has introduced a function of automated reports that enable the incidence and quarterly dynamics of diabetic complications to be estimated, including those detected for the first time and, crucially important, indicating the stage at the time of diagnosis. The report can be performed both for the region as a whole, and for each health facility, which enables the efficiency of their work to be evaluated. From this point of view, the registry becomes a key indicator of the quality of rendering specialised care that enables the efficiency of diabetes services in the regions to be monitored.

Diabetic nephropathy

Diabetic nephropathy was recorded in 20.1% of patients with T1DM and 6.3% of patients with T2DM.

The incidence of nephropathy ranged widely from 0.1% (the Republic of Kabardino-Balkaria) to 40.7% (the Saratov Region) in T1DM (Fig. 15), and from 0% (Republic of Kabardino-Balkaria) to 19, 9% (Altai Territory) in T2DM (Fig. 16).

Fig. 15 Prevalence of diabetic nephropathy in T1DM in 78 regions of the Russian Federation, 2016

Fig. 16 Prevalence of diabetic nephropathy in T2DM in 78 regions of the Russian Federation, 2016

Diabetic retinopathy

Diabetic retinopathy was recorded in 27.2% of patients with T1DM and 13.0% of patients with T2DM.

The incidence rate of diabetic retinopathy ranged from 0.1% (the Republic of Kabardino-Balkaria) to 57% (Chuvash Republic) in T1DM (Fig. 17), and from 0.1% (the Republic of Kabardino-Balkaria) to 35.9% (Kursk Region) (Fig. 18) in T2DM.

Fig. 17 Prevalence of diabetic retinopathy in T1DM in 78 regions of the Russian Federation, 2016

Fig. 18 Prevalence of diabetic retinopathy in T2DM in 78 regions of the Russian Federation, 2016

Diabetic neuropathy

Diabetic neuropathy was recorded in 33.6% of patients with T1DM and 18.6% of patients with T2DM.

The incidence rate of neuropathy ranged from 0.1% (the Republic of Kabardino-Balkaria) to 67.2% (Tambov Region) (Fig. 19) in T1DM, and from 0.1% (the Republic of Kabardino-Balkaria) to 42.4% (Kursk Region) (Fig. 20) in T2DM.

Fig. 19 Prevalence of diabetic neuropathy in T1DM in 78 regions of the Russian Federation, 2016

Fig. 20 Prevalence of diabetic neuropathy in T2DM in 78 regions of the Russian Federation, 2016

Diabetic foot syndrome

Diabetic foot syndrome was recorded in 4.3% of patients with T1DM and 2% of patients with T2DM.

The incidence rate of diabetic foot syndrome ranged from 0% (the Republic of Kabardino-Balkaria) to 19.5% (Lipetsk Region) (Fig. 21) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 16.2% (the Republic of Altai) (Fig. 22) in T2DM.

Fig. 21 Prevalence of diabetic foot syndrome in T1DM in 78 regions of the Russian Federation, 2016

Fig. 22 Prevalence of diabetic foot syndrome in T2DM in 78 regions of the Russian Federation, 2016  

Diabetic macroangiopathy

Diabetic macroangiopathy was recorded in 12.1% of patients with T1DM and 6% of patients with T2DM.

The incidence rate of macroangiopathy ranged from 0% (Sverdlovsk Region) to 35.1% (Magadan Region) (Fig. 23) in T1DM, and from 0% (the Republic of North Ossetia-Alania) to 20.6% (Kursk Region) (Fig. 24) in T2DM.

Fig. 23 Prevalence of diabetic macroangiopathy in T1DM in 78 regions of the Russian Federation, 2016

Fig. 24 Prevalence of diabetic macroangiopathy in T2DM in 78 regions of the Russian Federation, 2016

Arterial hypertension

Arterial hypertension was registered in 17.1% of patients with T1DM and 40.6% of patients with T2DM.

The incidence rate of hypertension ranged from 0% (the Republic of Kabardino-Balkaria) to 45.1% (Tambov Region) (Fig. 25) in T1DM, and from 0.1% (the Republic of Kabardino-Balkaria) to 88.7% (Altai Territory) (Fig. 26) in T2DM.

Fig. 25 Prevalence of arterial hypertension in T1DM in 78 regions of the Russian Federation, 2016

Fig. 26 Prevalence of arterial hypertension in T2DM in 78 regions of the Russian Federation, 2016

Ischaemic heart disease

Ischaemic heart disease was registered in 3.5% of patients with T1DM and in 11.0% of patients with T2DM.

The incidence rate of ischaemic heart disease ranged from 0% (Nenets Autonomous Area) to 19.1% (Oryol Region) (Fig. 27) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 29.4% (Kaliningrad Region) (Fig. 28) in T2DM.

Fig. 27 Prevalence of ischaemic heart disease in T1DM in 78 regions of the Russian Federation, 2016

Fig. 28 Prevalence of ischaemic heart disease in T2DM in 78 regions of the Russian Federation, 2016

Myocardial infarction

Myocardial infarction was recorded in 1.1% of patients with T1DM and 3.3% of patients with T2DM.

The incidence rate of myocardial infarction ranged from 0% (the Republic of Kabardino-Balkaria) to 3.1% (Leningrad Region) (Fig. 29) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 10.2% (the Republic of Altai) (Fig. 30) in T2DM.

Fig. 29 Prevalence of myocardial infarction in T1DM in 78 regions of the Russian Federation, 2016

Fig. 30 Prevalence of myocardial infarction in T2DM in 78 regions of the Russian Federation, 2016

Cerebrovascular diseases

Cerebrovascular diseases were recorded in 1.5% of patients with T1DM and 4.0% of patients with T2DM.

The incidence rate of cerebrovascular diseases ranged from 0% (Republic of North Ossetia-Alania) to 4.6% (Lipetsk Region) (Fig. 31) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 11.5% (the Republic of Altai) (Fig. 32) in T2DM.

Fig. 31 Prevalence of cerebrovascular diseases in T1DM in78 regions of the Russian Federation, 2016

Fig. 32 Prevalence of cerebrovascular diseases in T2DM in 78 regions of the Russian Federation, 2016

Conclusion

In assessing the data of the DM registry, the year 2016 became the focus since most of the regions of the Russian Federation transferred to the online format, which is a fundamentally new system of approach to registry management based on the creation of a dynamic database that enables multilevel monitoring of key clinical and epidemiological indicators.

In the Russian Federation in 2016 and from 2013–2016, the prevalence of DM grew persistently, mainly due to T2DM. There was a significant increase in the number of patients achieving a target HbA1c level of <7%, as well as a decrease in the proportion of patients with severe DM decompensation with HbA1c ≥9.0%; however, the frequency of measurement of this key indicator of treatment efficiency is unsatisfactory, as it was measured in less than a third of DM patients. This requires action to increase the availability of HbA1c monitoring. In the dynamics for the period 2013–2016, an increased life expectancy for patients with T2DM and a reduction in mortality in both types of DM was noted. The incidence of diabetic complications varied widely from region to region, which may reflect to a greater extent the differences in the quality of specialised primary care rather than geographical or ethnic determinants.

The new online registry system is a highly functional information and analytical platform with broad analysis capabilities, which can be used by health authorities as a key tool for assessing the current status, and planning and optimising the diabetes care in certain regions and in the Russian Federation as a whole.

Additional information

Financing of the work

The work was performed within the framework of the state task of the Ministry of Health of the Russian Federation No. АААА-А16-116011100138-5.

Conflict of interest

The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article.

Participation of authors

Shestakova M.V., Vikulova O.K. - analysis and interpretation of the study results, writing an article; Dedov I.I. - final analysis of the results and editing of the manuscript text.

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Appendix 1

Table 1. PREVALENCE OF DIABETES MELLITUS IN ALL AGE GROUPS ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Table 2. PREVALENCE RATE OF DM IN THE PEDIATRIC AGE GROUP ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Table 3. PREVALENCE RATE OF DM IN THE ADOLESCENT AGE GROUP ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Table 4. PREVALENCE RATE OF DM IN THE ADULT AGE GROUP ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Appendix 2

Table 1. INCIDENCE RATE OF DM ACCORDING TO THE DATA OF THE ON-LINE REGISTRY IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Appendix 3.

Table 1. MORTALITY IN DM ACCORDING TO THE DATA OF THE ONLINE REGISTRY IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016