problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl13426problendo-13426Research ArticleНарушения углеводного обменаCarbohidrates metabolism disturbanciesКомплексный анализ постковидных кардиоренальных осложнений у пациентов с сахарным диабетом 1 и 2 типа по данным мобильного лечебно-диагностического центра «Диамобиль»Multiplex analysis of post-Covid cardiorenal complications in patients with type 1 and type 2 diabetes mellitus according to the mobile diagnostic and treatment center (Diamobil)https://orcid.org/0000-0003-0571-8882ВикуловаО. К.VikulovaO. К.

Викулова Ольга Константиновна - д.м.н., доцент.

117036, Москва, ул. Дм. Ульянова, д. 11

Olga K. Vikulova - MD, PhD, associate professor

11 Dm. Ulyanova street, 117036 Moscow

gos.registr@endocrincentr.ruhttps://orcid.org/0000-0002-9524-0124ЖелезняковаА. В.ZheleznyakovaA. V.

Железнякова Анна Викторовна - к.м.н.

Москва

Anna V. Zheleznyakova - MD, PhD, senior research associate

Moscow

azhelez@gmail.comhttps://orcid.org/0000-0003-3398-5603СерковА. А.SerkovA. A.

Серков Алексей Андреевич

Москва

Alexey A. Serkov

Moscow

enc.rd2008@gmail.comhttps://orcid.org/0000-0001-9760-1117ИсаковМ. А.IsakovM. A.

Исаков Михаил Андреевич - к.б.н.

Москва

Mikhail А. Isakov - PhD in Biology

Moscow

m.isakov@aston-health.comВагаповаГ. Р.VagapovaG. R.

Вагапова Гульнара Рифатовна - д.м.н., проф.

Казань

Gulnar R. Vagapova

Kazan 

azhelez@gmail.comhttps://orcid.org/0000-0001-6000-8002ВалееваФ. В.ValeevaF. V.

Валеева Фарида Вадутовна - д.м.н., проф.

Казань

Farida V. Valeeva

Kazan 

azhelez@gmail.comТрубицынаН. П.TrubicinaN. P.

Трубицына Наталья Петровна - к.м.н.

Москва

Natalia P. Trubitsyna

Moscow

Trubitcina.Natalya@endocrincentr.ruhttps://orcid.org/0000-0002-0394-6913МельниковаО. Г.MelnikovaO. G.

Мельникова Ольга Георгиевна - к.м.н.

Москва

Olga G. Melnikova

Moscow

Melnikova.Olga@endocrincentr.ruАлександроваВ. К.AleksandrovaV. K.

Александрова Вера Кирилловна - к.м.н.

Москва

Vera K. Aleksandrova

Moscow

aleksandrova.vera@endocrincentr.ruСмирноваН. Б.SmirnovaN. B.

Смирнова Наталия Борисовна - к.м.н.

Москва

Natalia B. Smirnova

Moscow

Smirnova.Natalya@endocrincentr.ruЕгороваД. Н.EgorovaD. N.

Егорова Дарья Никитична - к.м.н.

Москва

Dariya N. Egorova

Moscow

Egorova.Dariya@endocrincentr.ruhttps://orcid.org/0000-0002-2232-4765АртемоваЕ. В.ArtemovaE. V.

Артемова Екатерина Викторовна

Москва

Ekaterina V. Artemova

Moscow

artemova.ekaterina@endocrincentr.ruСорокинаК. В.SorokinaK. V.

Сорокина Клия Вестовна

Москва

Kliya V. Sorokina

Moscow

sorkl@bk.ruhttps://orcid.org/0000-0002-5057-127XШестаковаМ. В.ShestakovaM. V.

Шестакова Марина Владимировна - д.м.н., проф., академик РАН

Москва

Marina V. Shestakova - MD, PhD, Professor.

Moscow

shestakova.mv@gmail.comhttps://orcid.org/0000-0002-9717-9742МокрышеваН. Г.MokryshevaN. G.

Мокрышева Наталья Георгиевна - д.м.н., проф., чл.-корр. РАН

Москва

Natalya G. Mokrysheva - MD, PhD, Professor.

Moscow

nm70@mail.ruhttps://orcid.org/0000-0002-8175-7886ДедовИ. И.DedovI. I.

Дедов Иван Иванович - д.м.н., проф., академик РАН.

Москва

Ivan I. Dedov - MD, PhD, Professor.

Moscow

dedov@endocrincentr.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian FederationКазанская государственная медицинская академияРоссияKazan State Medical AcademyRussian FederationКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian Federation2024150920247046574Copyright © Викулова О.К., Железнякова А.В., Серков А.А., Исаков М.А., Вагапова Г.Р., Валеева Ф.В., Трубицына Н.П., Мельникова О.Г., Александрова В.К., Смирнова Н.Б., Егорова Д.Н., Артемова Е.В., Сорокина К.В., Шестакова М.В., Мокрышева Н.Г., Дедов И.И., 20242024Викулова О.К., Железнякова А.В., Серков А.А., Исаков М.А., Вагапова Г.Р., Валеева Ф.В., Трубицына Н.П., Мельникова О.Г., Александрова В.К., Смирнова Н.Б., Егорова Д.Н., Артемова Е.В., Сорокина К.В., Шестакова М.В., Мокрышева Н.Г., Дедов И.И.Vikulova O.К., Zheleznyakova A.V., Serkov A.A., Isakov M.A., Vagapova G.R., Valeeva F.V., Trubicina N.P., Melnikova O.G., Aleksandrova V.K., Smirnova N.B., Egorova D.N., Artemova E.V., Sorokina K.V., Shestakova M.V., Mokrysheva N.G., Dedov I.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.probl-endojournals.ru/jour/article/view/13426РЕЗЮМЕ

РЕЗЮМЕ. Пациенты с сахарным диабетом (СД) относятся к группе риска большей частоты и тяжести течения COVID-19, а также его неблагоприятных исходов, в том числе постковидного синдрома.

ЦЕЛЬ

ЦЕЛЬ. Оценить частоту развития кардиоренальных осложнений у пациентов с СД 1 и 2 типа, перенесших COVID-19, и провести анализ структуры и тяжести нарушений по данным обследования в мобильном медицинском лечебно-диагностическом центре «Диамобиль».

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Когорта пациентов с СД 1 и 2 типа, обследованных в «Диамобиле» (n=318), с подтвержденным в анамнезе COVID-19 (n=236). Временной интервал между COVID-19 и визитом в «Диамобиль» составил 8,7/8,2 мес. при СД1/СД2. В качестве исходных данных использовались параметры последнего визита до COVID-19, зафиксированного в Федеральном регистре СД (ФРСД).

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Клиническая характеристика пациентов с СД1/СД2: возраст — 49,2/64,5 года, длительность СД — 22/11 лет, доля женщин — 64/73% соответственно. При анализе данных визитов до и после COVID-19 статистически значимых отличий по уровню HbA1c при обоих типах СД не отмечено (до — 9,0/8,3%; после — 8,4/8,2% соответственно), в том числе вследствие интенсификации терапии (возросла доля пациентов с СД2 на 2- и 3-компонентной терапии на 4,3 и 1,6%, доля пациентов на инсулинотерапии — на 16%). После COVID-19 отмечалось статистически значимое снижение скорости клубочковой фильтрации (СКФ) при СД1 с 88,1 до 62 мл/мин/1,73 м2; при СД2 — с 74,7 до 54,1 мл/мин/1,73 м2. При оценке острых диабетических осложнений отмечено увеличение частоты ком при СД1 в 1,5 раза, тяжелых гипогликемий при СД1 — в 3 раза, при СД2 — в 1,7 раза. Анализ частоты кардиоренальных осложнений до и после COVID-19 показал суммарное увеличение на 8,5% — при СД1, на 13,2% — при СД2, из них инфаркт миокарда, ИБС, ХСН увеличились при СД1 в диапазоне от 1,5 до 5 раз, при СД2 — в 1,3 раза, частота ХБП при СД1 — в 1,5 раза, при СД2 — в 5,6 раза.

ВЫВОДЫ

ВЫВОДЫ. При стабильных показателях HbA1c, достигнутых на фоне интенсификации терапии в период COVID-19, в постковидном периоде отмечается ухудшение функциональной способности почек (снижение СКФ) и увеличение частоты сердечно-сосудистых осложнений при обоих типах СД, что отражает факт сочетанного поражения почек и сердечно-сосудистой системы в рамках постковидного синдрома и определяет ключевой спектр мероприятий для разработки мер профилактики.

BACKGROUND

BACKGROUND: Patients with diabetes mellitus (DM) are at risk for a higher incidence and severity of COVID-19, as well as its adverse outcomes, including post-Covid syndrome.

AIM

AIM: to assess the incidence of cardiorenal complications in patients with type 1 and type 2 diabetes (T1DM/T2DM) who have had COVID-19, and to analyze the structure and severity of disorders according to examination data at the Diamobil mobile medical diagnostic and treatment center.

MATERIALS AND METHODS

MATERIALS AND METHODS: a cohort of T1DM and T2DM patients examined in Diamobil (n=318), with a confirmed anamnesis of COVID-19 (n=236). The time interval between COVID-19 and the visit to Diamobil was 8.7/8.2 months for T1DM/T2DM. The parameters of the last visit before COVID-19 recorded in the Federal Register of Diabetes (FRD) were used as initial data.

RESULTS

RESULTS: Clinical characteristics of patients with T1DM/T2DM: age — 49.2/64.5 years, duration of DM — 22/11 years, proportion of women — 64/73%, respectively. After analysis the data from visits before and after COVID-19 there weren’t statistically significant differences in HbA1c levels for both types of DM (before 9.0/8.3%; after 8.4/8.2%, respectively), there was the intensification of glucose lowering therapy (the proportion of patients with T2DM on 2 and 3 component therapy increased by 4.3% and 1.6%, the proportion of patients on insulin therapy by 16%). After COVID-19, there was a statistically significant decrease in glomerular filtration rate (GFR) in T1DM from 88.1 to 62 ml/min/1.73 m2; with T2DM from 74.7 to 54.1 ml/min/1.73 m2. When assessing acute diabetic complications, there was an increase in the frequency of coma in T1DM by 1.5 times, severe hypoglycemia in T1DM by 3 times, and in T2DM by 1.7 times. Analysis of the frequency of cardiorenal complications before and after COVID-19 showed a total increase of 8.5% in T1DM, by 13.2% in T2DM, of which myocardial infarction, ischemic heart disease, and CHF increased in T1DM in the range from 1.5 to 5 times, with T2DM by 1.3 times, the frequency of CKD with T1DM by 1.5 times, with T2DM by 5.6 times.

CONCLUSION

CONCLUSION: There was a decline of kidney filtration function (decrease in GFR) and an increase in the frequency of cardiovascular complications in both types of diabetes in post-Covid period while patients achieved a stable HbA1c levels by intensifying therapy during the COVID-19 infection. This fact reflects combined damage to the kidney and cardiovascular system as a part of the post-Covid syndrome and determines a key set of measures for the development of preventive strategies.

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