Алгоритмы. Министерство здравоохраненияРоссийской Федерацииоо Российская ассоциация эндокринологов
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Galstyan G. PhD, Head of the Department of Diabetic Foot, Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Kuraeva T. Professor, Chief Researcher of the Department of Pediatric Diabetes, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Peterkova V. Fellow of the Russian Academy of Sciences, Professor, Scientific chief of Pediatric Endocrinology Institution, Head of the Chair of Pediatric Endocrinology-Diabetology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation, Chief Pediatric Endocrinologist of the Ministry of Health of the Russian Federation Smirnova O. Professor, Chief Specialist of the Editorial Department, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Starostina E. PhD, Professor of the Chair of Endocrinology, Postgraduate Training Faculty, M.F. Vladimirsky Moscow Regional Clinical and Research Institute of the Ministry of Health of Moscow region Surkova E. PhD, Chief Researcher of the Department of Diabetes Therapy, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Sukhareva O. Candidate of Medical Sciences, Senior Researcher of the Department of Diabetic Kidney Disease and Post-transplant Rehabilitation, Assistant Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Tokmakova A. PhD, Chief Researcher of the Department of Diabetic Foot, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Сахарный диабет.2021;24(S1). DOI: 10.14341/DM12802 9 Shamkhalova M. PhD, Head of the Department of Diabetic Kidney Disease and Post- transplant Rehabilitation, Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Jarek-Martynowa I. Candidate of Medical Sciences, Deputy of Chief Doctor of Endocrinology Research Centre, Senior Researcher of the Department of Diabetic Kidney Disease and Post-transplant Rehabilitation, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Artemova E. Researcher of the Department of Diabetic Foot, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Beshlieva D. Physician of the Department of Cardiology and Vascular Surgery, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Bondarenko O. Candidate of Medical Sciences, Senior Researcher of the Department of Diabetic Foot, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Volevodz N. PhD, Deputy of Director of Endocrinology Research Centre, Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Gomova I. Candidate of Medical Science, Physician of the Department of Cardiology and Vascular Surgery, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Grigoryan O. PhD, Chief Researcher of the Department of Endocrinological Gynecology, Professor of the Chair of Endocrinology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Dzhemilova Z. Researcher of the Department of Diabetic Foot, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Esayan R. Candidate of Medical Sciences, Head of the Therapeutic Department, V.I. Kulakov Obstetrician, Gynecology and Perinatology Research Centre of the Ministry of Health of the Russian Federation Ibragimova L. Candidate of Medical Science, Senior Researcher of the Department “Diabetes and Pregnancy”, Assistant Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Kononenko I. Candidate of Medical Sciences, Head of the Department of Research and Development of the Coordination Council, Assistant Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Kalashnikov V. Corresponding Member of the Russian Academy of Sciences, PhD, Head of the Coordination Council - Deputy of Director of Endocrinology Research Centre, Head of the Department of Cardiology and Vascular Surgery, Professor of the Chair of Endocrinology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Laptev D. PhD, Head of the Department of Pediatric Diabetes, Professor of the Chair of Pediatric Endocrinology-Diabetology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Lipatov D. PhD, Head of the Department of Diabetic Retinopathy and Ophthalmic Surgery, Endocrinology Research Centre of the Ministry of Health of the Russian Federation 10 Сахарный диабет.2021;24(S1). DOI: 10.14341/DM12802 Melnikova O. Candidate of Medical Sciences, Senior Researcher of the Department of Diabetes Therapy, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Mikhina M. Physician of the Department of Diabetes Therapy, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Michurova M. Researcher of the Department of Cardiology and Vascular Surgery, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Motovilin O. Candidate of Psychological Sciences, Senior Researcher of the Department of Diabetes Therapy, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Nikonova T. PhD, Head of the Department of Drug and Medical Devices of the Coordination Council, Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Rozhivanov R. PhD, Chief Researcher of the Department of Andrology and Urology, Professor of the Chair of Endocrinology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Sklyanik I. Candidate of Medical Science, Researcher of the Department of Diabetes Therapy, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Shestakova E. Candidate of Medical Science, Senior Researcher of the Department of Diabetes Therapy, Assistant Professor of the Chair of Diabetology and Dietology, Endocrinology Research Centre of the Ministry of Health of the Russian Federation Сахарный диабет.2021;24(S1). DOI: 10.14341/DM12802 11 Reviewed and approved by the following experts: Ametov A. Professor, Head of the Chair of Endocrinology, Russian Medical Academy of Continuing Professional Education of the Ministry of Health of the Russian Federation Antsiferov M. Professor, Head of Moscow Endocrinology Health Centre, Professor of the Chair of Endocrinology, Russian Medical Academy of Continuing Professional Education, Chief Endocrinologist of Moscow Health Department Mkrtumyan A. Professor, Head of the Chair of Endocrinology and Diabetology, A.I. Yevdokimov Moscow State University of Medicine and Dentistry of the Ministry of Health of the Russian Federation Petunina N. Corresponding Member of the Russian Academy of Sciences, Professor, Head of the Chair of Endocrinology, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Chief Endocrinologist of the Central Federal District Khalimov Yu. Professor, Head of the Chair of Military Field Therapy, S.M. Kirov Military Medical Academy, Chief Endocrinologist of the Ministry of Defense of the Russian Federation, Chief Endocrinologist of St-Petersburg Health Committee 12 Сахарный диабет.2021;24(S1). DOI: 10.14341/DM12802 СОДЕРЖАНИЕ ПРЕДИСЛОВИЕ К ДЕCЯТОМУ ВЫПУСКУ ......................................................................................................................... 14 1. ОПРЕДЕЛЕНИЕ САХАРНОГО ДИАБЕТА И ЕГО КЛАССИФИКАЦИЯ ....................................................................... 17 2. ДИАГНОСТИКА САХАРНОГО ДИАБЕТА ........................................................................................................................ 19 2.1. ДИАГНОСТИЧЕСКИЕ КРИТЕРИИ СД И ДРУГИХ НАРУШЕНИЙ ГЛИКЕМИИ (ВОЗ, 1999–2013) ................ 19 2.2. НbA1с КАК ДИАГНОСТИЧЕСКИЙ КРИТЕРИЙ СД ................................................................................................ 20 2.3. ДИФФЕРЕНЦИАЛЬНАЯ ДИАГНОСТИКА ............................................................................................................... 21 3. ТЕРАПЕВТИЧЕСКИЕ ЦЕЛИ ПРИ САХАРНОМ ДИАБЕТЕ 1 И 2 ТИПА ...................................................................... 22 3.1. ПОКАЗАТЕЛИ КОНТРОЛЯ УГЛЕВОДНОГО ОБМЕНА (ИНДИВИДУАЛЬНЫЕ ЦЕЛИ ЛЕЧЕНИЯ) ................ 22 3.2. МЕТОДЫ КОНТРОЛЯ УРОВНЯ ГЛЮКОЗЫ ............................................................................................................ 24 3.3. ЦЕЛЕВЫЕ УРОВНИ ПОКАЗАТЕЛЕЙ ЛИПИДНОГО ОБМЕНА ............................................................................ 26 3.4. ЦЕЛЕВЫЕ УРОВНИ ПОКАЗАТЕЛЕЙ АРТЕРИАЛЬНОГО ДАВЛЕНИЯ ............................................................... 26 4. ТРЕБОВАНИЯ К ФОРМУЛИРОВКЕ ДИАГНОЗА ПРИ САХАРНОМ ДИАБЕТЕ .......................................................... 27 5. САХАРНЫЙ ДИАБЕТ 1 ТИПА ............................................................................................................................................ 27 5.1. Лечение СД 1 типа ........................................................................................................................................................ 28 5.1.1. Инсулинотерапия СД 1 типа ............................................................................................................................... 28 5.1.2. Помповая инсулинотерапия ................................................................................................................................ 30 5.1.3. Техника инъекций и инфузии инсулина ............................................................................................................. 32 5.1.4. Рекомендации по питанию .................................................................................................................................. 33 5.1.5. Рекомендации по физической активности.......................................................................................................... 33 5.2. МОНИТОРИНГ БОЛЬНЫХ СД 1 ТИПА БЕЗ ОСЛОЖНЕНИЙ ............................................................................... 35 6. САХАРНЫЙ ДИАБЕТ 2 ТИПА ............................................................................................................................................ 36 6.1. ЛЕЧЕНИЕ СД 2 ТИПА ................................................................................................................................................. 36 6.1.1. Рекомендации по питанию .................................................................................................................................. 36 6.1.2. Рекомендации по физической активности.......................................................................................................... 37 6.1.3. Медикаментозная терапия ................................................................................................................................... 38 6.1.4. Рекомендуемый темп интенсификации лечения у больных СД 2 типа в зависимости от уровня HbA1c в дебюте ............................................................................................................................................................................ 45 6.1.5. Рациональные комбинации сахароснижающих препаратов.............................................................................. 47 6.1.6. Персонализация выбора сахароснижающих препаратов ................................................................................... 48 6.1.7. Инсулинотерапия ................................................................................................................................................. 53 6.1.8. Техника инъекций сахароснижающих препаратов ............................................................................................ 57 6.2. МОНИТОРИНГ БОЛЬНЫХ СД 2 ТИПА БЕЗ ОСЛОЖНЕНИЙ ............................................................................... 58 7. ТЕРАПЕВТИЧЕСКОЕ ОБУЧЕНИЕ И ПСИХОСОЦИАЛЬНАЯ ПОДДЕРЖКА БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ ..................................................................................................................................................................................................... 59 7.1. ТЕРАПЕВТИЧЕСКОЕ ОБУЧЕНИЕ БОЛЬНЫХ СД .................................................................................................. 59 7.2. ПСИХОСОЦИАЛЬНАЯ ПОДДЕРЖКА БОЛЬНЫХ СД ............................................................................................ 61 8. ОСТРЫЕ ОСЛОЖНЕНИЯ САХАРНОГО ДИАБЕТА......................................................................................................... 62 8.1. ДИАБЕТИЧЕСКИЙ КЕТОАЦИДОЗ (ДКА, ДИАБЕТИЧЕСКАЯ КЕТОАЦИДОТИЧЕСКАЯ КОМА) .................. 62 8.2. ГИПЕРОСМОЛЯРНОЕ ГИПЕРГЛИКЕМИЧЕСКОЕ СОСТОЯНИЕ (ГГС) ............................................................. 67 Сахарный диабет.2021;24(S1). DOI: 10.14341/DM12802 13 8.3. МОЛОЧНОКИСЛЫЙ АЦИДОЗ (ЛАКТАТАЦИДОЗ) ............................................................................................... 70 8.4. ГИПОГЛИКЕМИЯ И ГИПОГЛИКЕМИЧЕСКАЯ КОМА ......................................................................................... 72 9. ДИАБЕТИЧЕСКИЕ МИКРОАНГИОПАТИИ ...................................................................................................................... 73 9.1. ДИАБЕТИЧЕСКАЯ РЕТИНОПАТИЯ ......................................................................................................................... 74 9.2. ДИАБЕТИЧЕСКАЯ НЕФРОПАТИЯ ........................................................................................................................... 78 10. ДИАБЕТИЧЕСКИЕ МАКРОАНГИОПАТИИ .................................................................................................................... 91 10.1. ИШЕМИЧЕСКАЯ БОЛЕЗНЬ СЕРДЦА (ИБС) ......................................................................................................... 92 10.2. ЦЕРЕБРОВАСКУЛЯРНЫЕ ЗАБОЛЕВАНИЯ .......................................................................................................... 97 10.3. ЗАБОЛЕВАНИЯ АРТЕРИЙ НИЖНИХ КОНЕЧНОСТЕЙ ....................................................................................... 99 10.4. ТАКТИКА ДИАГНОСТИКИ И ЛЕЧЕНИЯ ИБС У БОЛЬНЫХ СД И КРИТИЧЕСКОЙ ИШЕМИЕЙ НИЖНИХ КОНЕЧНОСТЕЙ ................................................................................................................................................................ 109 11. ХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬ ................................................................................................ 110 12. ДИАБЕТИЧЕСКАЯ НЕЙРОПАТИЯ ................................................................................................................................ 116 12.1. КАРДИОВАСКУЛЯРНАЯ АВТОНОМНАЯ НЕЙРОПАТИЯ ............................................................................... 121 13. ДИАБЕТИЧЕСКАЯ НЕЙРООСТЕОАРТРОПАТИЯ ....................................................................................................... 126 14. СИНДРОМ ДИАБЕТИЧЕСКОЙ СТОПЫ ........................................................................................................................ 129 15. САХАРНЫЙ ДИАБЕТ И АРТЕРИАЛЬНАЯ ГИПЕРТЕНЗИЯ ....................................................................................... 138 16. БЕРЕМЕННОСТЬ И САХАРНЫЙ ДИАБЕТ ................................................................................................................... 144 17. ГЕСТАЦИОННЫЙ САХАРНЫЙ ДИАБЕТ ..................................................................................................................... 149 18. КОНТРАЦЕПЦИЯ ПРИ САХАРНОМ ДИАБЕТЕ........................................................................................................... 153 19. САХАРНЫЙ ДИАБЕТ У ДЕТЕЙ И ПОДРОСТКОВ ...................................................................................................... 156 19.1. САХАРНЫЙ ДИАБЕТ 1 ТИПА ............................................................................................................................... 156 19.2. НЕИММУННЫЕ ФОРМЫ СД ................................................................................................................................. 160 19.3. МЕДИКО-ГЕНЕТИЧЕСКОЕ КОНСУЛЬТИРОВАНИЕ СЕМЕЙ БОЛЬНЫХ СД ................................................ 167 19.4. ПЕРЕХОД БОЛЬНОГО СД ИЗ ПЕДИАТРИЧЕСКОЙ ВО ВЗРОСЛУЮ МЕДИЦИНСКУЮ СЛУЖБУ ............ 167 20. САХАРНЫЙ ДИАБЕТ В ПОЖИЛОМ ВОЗРАСТЕ......................................................................................................... 169 21. СИНДРОМ ГИПОГОНАДИЗМА У МУЖЧИН С САХАРНЫМ ДИАБЕТОМ ............................................................. 173 22. ПЕРИОПЕРАЦИОННОЕ ВЕДЕНИЕ БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ ............................................................. 174 23. ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ САХАРНОГО ДИАБЕТА ............................................................................................. 179 24. ПРОФИЛАКТИКА САХАРНОГО ДИАБЕТА 2 ТИПА .................................................................................................. 182 25. ВАКЦИНАЦИЯ ................................................................................................................................................................. 184 26. ФЕДЕРАЛЬНЫЙ РЕГИСТР БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ ............................................................................ 185 27. ПРИЛОЖЕНИЯ .................................................................................................................................................................. 189 ЛИТЕРАТУРА ......................................................................................................................................................................... 217 СПИСОК СОКРАЩЕНИЙ ...................................................................................................................................................... 224 ИЗМЕНЕНИЯ ПО СРАВНЕНИЮ С ПРЕДЫДУЩИМ ИЗДАНИЕМ (подписанным в печать 10.09.2021): ..................... 226 |