Epidemiology of acute diabetes complications (coma) according to the Federal Diabetes register of the Russian Federation (2013–2016)

Background: Despite the improvement in the quality of diabetes care in the Russian Federation (RF), coma remain one of the causes of death in patients with diabetes.

Aim: To assess dynamic of epidemiological characteristic of acute complications in adult patients with T1D and T2D in 2013–16.

Materials and methods: The database of the Russian Federal Diabetes register (81 regions). The indicators of coma for 2013–16 were estimated for 10000 adult patients with diabetes (>18 years).

Results: In 2016, the prevalence of coma in RF was 225.9 with T1D and 11.6/10000 adults with T2D. For the period from 2007 the prevalence of ketoacidotic coma decrease three times in T1D, 4 times for T2D.Totally in 2016, 165 new cases of coma for both types of diabetes were registered, an average of 0.4/10000 adults. Interregional differences in the prevalence of coma were observed 0–4.2/10000 adults. The frequency of new cases of coma has a tendency to decrease: 0,9→0,4/10000 adults: T1D 5.7→3.4, T2D 0.6→0.2/10000 adults. When evaluating the structure of coma, redistribution is evident in their form. So in 2016 the proportion of hypoglycemic coma increased to 40.7%, and ketoacidotic coma decreased to 56.6% in T1D. With T2D, the difference expressed in a lesser degree. The mean duration of diabetes at the time of coma development increased with T1D from 3.8→9.1 years, with T2D 3.5→7.0 years. The maximum frequency of development of coma is recorded with the diabetes duration more than 30 years, regardless of the type. The patients’ age at the time of coma development in T1D increased to 27.5 years old, and in T2D it was 60.4 years, it didn’t change significantly. The assessment of glycemic control showed a significant improvement: a decrease in the proportion of patients with HbA1c≥ 9.0% (23% with T1D, 8.8% with T2D), an increase with HbA1c <7% (32.4% and 51.7%, respectively). The average value of HbA1c in 2016 with T1D – 8.21%, with T2D – 7.48%.

Conclusions: It is established that the dynamics of the frequency of development of coma in 2013–16 in adult patients with diabetes in the RF has a stable tendency to decrease: 1.5 times with T1D and more than 3 times with T2D. It can be assumed that this is due to the improvement in the quality of diabetes care and glycemic control in general, as well as the use of modern medicines. Attention is required to draw to the high frequency of coma in T1D, the development of coma with a longer duration of diabetes, an increase in the proportion of patients with hypoglycemic coma. Significant interregional differences in the frequency of coma registration require additional analysis.

diabetes, Federal Register of Diabetes, ketoacidotic coma, hypoglycemic coma

1. Дедов И.И., Шестакова М.В., Викулова О.К., Железнякова А.В., Исаков М.А. Сахарный диабет в Российской Федерации: распространенность, заболеваемость, смертность, параметры углеводного обмена и структура сахароснижающей терапии по данным Федерального регистра сахарного диабета, статус 2017 г. // Сахарный диабет. – 2018. —Т. 21. – №3. – С. 144-159. [Dedov II, Shestakova MV, Vikulova OK, Zheleznyakova AA, Isakov MA. Diabetes mellitus in Russian Federation: prevalence, morbidity, mortality, parameters of glycaemic control and structure of hypoglycaemic therapy according to the Federal Diabetes Register, status 2017. Diabetes Mellitus. 2018;21(3):144-159. (In Russ.)] doi: 10.14341/DM9686

2. Осложнения сахарного диабета, лечение и профилактика / Под ред. Дедова И.И., Шестаковой М.В. – М.: МИА, 2017. [Dedov II, Shestakova MV, editors. Oslozhneniya sakharnogo diabeta, lechenie i profilaktika. Moscow: MIA; 2017. (In Russ.)]

3. Дедов И.И., Шестакова М.В., Викулова О.К. Государственный регистр сахарного диабета в Российской Федерации: статус 2014 г. и перспективы развития // Сахарный диабет. – 2015. – T. 18. – №3. – С. 5-22. [Dedov II, Shestakova MV, Vikulova OK. National register of diabetes mellitus in Russian Federation: status on 2014. Diabetes mellitus. 2015;18(3):5-23. (In Russ.)] doi: 10.14341/DM201535-22

4. Неврология. Национальное руководство. Том 1. / Под ред. Гусева Е.И., Коновалова А.Н., Скворцовой В.И., Гехт А.Б. – М.: ГЭОТАР-Медиа, 2018. [Guseva EI, Konovalova AN, Skvortsova VI, Geht AB, editors. Neurologia. Nacionalnoe rukovodstvo. Moscow: GEOTAR-media; 2018. (In Russ)]

5. Дедов И.И., Шестакова М.В., Майоров А.Ю., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. / Под ред. Дедова И.И., Шестаковой М.В., Майорова А.Ю. 8-й выпуск // Сахарный диабет. – 2017. – Т. 20. – №1S. – C. 1-121. [Dedov II, Shestakova MV, Mayorov AY, et al. Dedov II, Shestakova MV, Mayorov AY, editors. Standards of specialized diabetes care. 8th ed. Diabetes mellitus. 2017;20(1S):1-121. (In Russ.)] doi: 10.14341/DM20171S8

6. Дедов И.И., Шестакова М.В., Сунцов Ю.И., и др. Результаты реализации подпрограммы «Сахарный диабет» Федеральной целевой программы «Предупреждение и борьба с социально значимыми заболеваниями 2007-2012 годы» // Сахарный диабет. – 2013. – Т. 16. – №2S. – C. 1-48. [Dedov II, Shestakova MV, Suntsov YI, et al. Federal targeted programme “Prevention and Management of Socially Significant Diseases (2007-2012)”: results of the “Diabetes mellitus” sub-programme. Diabetes mellitus. 2013;16(2S):1-48. (In Russ.)] doi: 10.14341/2072-0351-3879

7. Дедов И.И., Шестакова М.В., Викулова О.К. Эпидемиология сахарного диабета в Российской Федерации: клинико-статистический анализ по данным Федерального регистра сахарного диабета // Сахарный диабет. – 2017. – T. 20. – №1. – C. 13-41. [Dedov II, Shestakova MV, Vikulova OK. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes mellitus. 2017;20(1):13-41. (In Russ.)] doi: 10.14341/DM8664

8. Karges B, Rosenbauer J, Kapellen T, et al. Hemoglobin A1c Levels and risk of severe hypoglycemia in children and young adults with type 1 diabetes from Germany and Austria: a trend analysis in a cohort of 37,539 patients between 1995 and 2012. PLoS Med. 2014;11(10):e1001742. doi: 10.1371/journal.pmed.1001742

9. U.K. Hypoglycaemia Study Group. Risk of hypoglycaemia in types 1 and 2 diabetes: effects of treatment modalities and their duration. Diabetologia. 2007;50(6):1140 –1147. doi: 10.1007/s00125-007-0599-y

10. Мкртумян А.М., Чагай Н.Б. Сахарный диабет. Стратегия современной сахароснижающей терапии. Неотложные состояния. М.: Медфорум, 2017 С 92 ISBN978-5-9500559-0-4. [Mrktumyan AM, Chagay NB. Saharnij diabet. Strategia sovremennoj saharosnizhauchey terspii. Neotlozhnie sostoyania. Moscow: Medforum; 2017. (In Russ.)]

11. Потемкин В.В., Старостина Е.Г. Руководство по неотложной эндокринологии. – М.: ООО МИА, 2008. [Potemkin VV, Starostina EG. Rukovodstvo po neotlojnoj endocrinologii. Moscow: MIA; 2008. (in Russ)]

12. Старостина Е.Г. Гипогликемия и гипогликемическая кома // Медицинский совет. – 2013. – №5-6. – С. 6-10. [Starostina EG. Hypoglycemia and hypoglemic coma. Med sovet. 2013;(5-6):6-10. (In Russ.)]

13. Мельникова О.Г., Майоров А.Ю. Клинические и психологические аспекты гипогликемии при сахарном диабете // Сахарный диабет. – 2010. – Т. 13. – №3 – С. 46-50 [Mel'nikova OG, Mayorov AY. Clinical and psychological aspects of hypoglycemia in patients with diabetes mellitus. Diabetes mellitus. 2010;13(3):46-50. (In Russ.)] doi.org/10.14341/2072-0351-5487

14. Дедов И.И., Сунцов Ю.И., Болотская Л.Л., и др. Скрининг осложнений сахарного диабета как метод оценки лечебно-профилактической помощи больным // Сахарный диабет. – 2006. – Т. 9. – №4. – C. 38-42. [Dedov II, Suntsov YI, Bolotskaya LL, et al. Skrining oslozhneniy sakharnogo diabetakak metod otsenki lechebno-profilakticheskoypomoshchi bol'nym. Diabetes mellitus. 2006;9(4):38-42. (In Russ.)] doi: 10.14341/2072-0351-6188

15. DCCT Research Group: Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med. 1991;90(4):450-459. doi: 10.1016/0002-9343(91)80085-z

16. Мельникова О.Г. Британское проспективное исследование сахарного диабета (UKPDS) – результаты 30-летнего наблюдения больных сахарным диабетом 2 типа // Сахарный диабет. – 2008. – T. 11. – №4. – C.91-92 [Melnikova OG. Britanskoe prospectivnoe issledovanie saharnogo diabeta (UKPDS) resultati 30-letnego nabludenia bolnih saharnim diabetom 2 tipa. Diabetes mellitus. 2008;11(4):91-91. (In Russ.)] doi: 10.14341/2072-0351-5599

17. Zhong VW, Juhaeri J, Cole SR, et al. Incidence and Trends in Hypoglycemia Hospitalization in Adults With Type 1 and Type 2 Diabetes in England, 1998-2013: A Retrospective Cohort Study. Diabetes Care. 2017;40(12):1651-1660. doi: 10.2337/dc16-2680