diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12990diaendo-12990Research ArticleКлинический случайCase reportОптимизация контроля гликемии на фоне непрерывного мониторирования глюкозы у пациентки с сахарным диабетом 1 типа, получающей заместительную почечную терапию программным гемодиализомOptimization of glycemic control with continuous glucose monitoring in a patient with type 1 diabetes mellitus undergoing maintenance hemodialysishttps://orcid.org/0000-0002-8798-887XМарковаТ. Н.MarkovaT. N.

Маркова Татьяна Николаевна – доктор медицинских наук, профессор кафедры эндокринологии и диабетологии МГМСУ им. А.И. Евдокимова; заведующая отделением эндокринологии ГКБ № 52.

Москва

Tatyana N. Markova - MD, PhD, Professor.

Moscow

markovatn18@yandex.ruhttps://orcid.org/0000-0001-8062-7847ЯворскаяВ. О.YavorskayaV. O.

Яворская Виктория Олеговна – аспирант, кафедра эндокринологии и диабетологии МГМСУ им. А.И. Евдокимова.

127473, Москва, ул. Делегатская, д. 20, стр. 1

Victoria O. Yavorskaya - MD, PhD student.

20/1 Delegatskaja street, 127473 Moscow

victoria.tsuprova@gmail.comhttps://orcid.org/0000-0002-3375-1260СубботинаЛ. С.SubbotinaL. S.

Субботина Луиза Сергеевна - врач-эндокринолог.

Москва

Luiza S. Subbotina – MD.

Moscow

luiza_subbotina@internet.ruhttps://orcid.org/0000-0002-3959-6281УшаковаА. И.UshakovaA. I.

Ушакова Анжела Ильинична - заведующая отделением гемодиализа ГКБ № 52.

Москва

Anzhela I. Ushakova – MD.

Moscow

anzhela_52@inbox.ruФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава России; Городская клиническая больница №52РоссияMoscow State University of Medicine and Dentistry named after A.I. Evdokimov; Moscow City Hospital 52Russian FederationФГБОУ ВО «Московский государственный медико-стоматологический университет имени А.И. Евдокимова» Минздрава РоссииРоссияMoscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian FederationГородская клиническая больница №52РоссияMoscow City Hospital 52Russian Federation202330052023264363369Copyright © Маркова Т.Н., Яворская В.О., Субботина Л.С., Ушакова А.И., 20232023Маркова Т.Н., Яворская В.О., Субботина Л.С., Ушакова А.И.Markova T.N., Yavorskaya V.O., Subbotina L.S., Ushakova A.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12990

Пациенты с сахарным диабетом (СД), получающие заместительную почечную терапию (ЗПТ) программным гемодиализом (ГД), склонны к развитию гипогликемий, а также к высокой вариабельности гликемии как в диализные, так и недиализные дни. Надежность и ценность гликированного гемоглобина у диализных больных СД в качестве маркера компенсации углеводного обмена снижена вследствие влияния анемии, уремии, механического повреждения эритроцитов при диффузии через диализирующую мембрану. Непрерывное мониторирование гликемии (НМГ) является одним из методов контроля и коррекции вариабельности гликемии у диализных пациентов с СД.

В данной статье представлено описание клинического случая пациентки с СД 1 типа (СД1) на ЗПТ ГД, получающей инсулинотерапию (ИТ) с помощью инсулиновой помпы в сочетании с НМГ (портативная система FreeStyle Libre), и освещены сложности коррекции ИТ в диализные и недиализные дни. В разделе «Обсуждение» представлены рекомендации JBDS-IP 2022 (Британия) по коррекции ИТ у пациентов с СД на диализе (рекомендовано снижение дозы инсулина на 25% в диализные дни, непосредственно сразу после начала процедуры ГД). Особое внимание акцентировано на необходимости персонализированного подхода к коррекции ИТ у диализных больных СД в связи с коморбидностью данной группы пациентов и трудностями в экстраполировании рекомендаций в реальную клиническую практику.

Patients with type 1 Diabetes Mellitus (T1DM) on renal replacement therapy with maintenance hemodialysis (MHD) are prone to develop hypoglycemia, as well as high glycemic variability on both dialysis and non-dialysis days. Reliability of glycated hemoglobin in dialysis patients with DM as a marker of carbohydrate metabolism compensation is reduced due to the influence of anemia, uremia, mechanical damage of erythrocytes during diffusion through the dialyzing membrane. Continuous glucose monitoring (CGM) is one of the methods for monitoring and correction glycemic variability in dialysis patients with DM.

This article presents a description of a clinical case of the patient with T1DM on MHD receiving insulin therapy using an insulin pump in combination with CGM (FreeStyle Libre portable system) and highlights the difficulties of correcting insulin therapy on dialysis and non-dialysis days.

The discussion section presents the JBDS-IP 2022 (UK) recommendations for the correction of insulin therapy in patients with DM on dialysis (it is recommended to reduce the insulin dose by 25% on dialysis days, immediately after the start of the HD procedure). Particular attention is focused on the need for a personalized approach to the correction of insulin therapy in dialysis patients with DM due to the comorbidity of this group of patients and the difficulties in extrapolating recommendations into real clinical practice.

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The authors declare that there are no conflicts of interest present.