Analysis of Medical Status of Patients with Type 2 Diabetes Mellitus and Its Impact on the Development of Complications

The assessment of quality of diabetes care in the implementation of new clinical protocol is an urgent problem. The objective of the study — to assess the medical status of patients with type 2 diabetes mellitus according to parameters in dynamics (2012–2013), which were indicated in the standardized clinical protocol for annual monitoring, as well as to carry out an additional complete physical examination of patients (2014) to determine the effect of their health status on development of micro- and macrovascular complications (as an additional indicator of medical care quality). Materials and Methods. 92 patients with type 2 diabetes mellitus aged 58.90 ± 1.17 years were examined ( 55 women and 37 men, duration of diabetes — 6.2 ± 2.1 years), in order to evaluate their health status, we have analysed medical records. We have carried out a survey of patients about risk factors for complications, compliance with the recommendations and adherence to treatment, as well as clinical-laboratory and instrumental examination (blood pressure, body mass index, heart rate, HbA1c, lipidogram, C-reactive protein, uric acid, urine albumin/creatinine ratio, evaluation of carbon monoxide in breath, parameters of echocardiography and Doppler ultrasound of carotid arteries). For comparison, by the same indicators we have examined 30 apparently healthy individuals without diabetes mellitus of appropriate age — 49.43 ± 5.60 years (18 women and 12 men). Statistical analysis — using Excel 2007, SPSS. Results. Recommended by standardized clinical protocol, annual monitoring of indicators and implementation of preventive measures in patients with type 2 diabetes mellitus in the Kyiv region in 2012–2013 was carried out not in full on both the primary and secondary levels. We have monitored not all recommended indicators and not in all patients, besides preventive measures for correction of patients’ status was provided not in full, and as a result, not all patients achieved target levels of performance. Comprehensive survey of patients in 2014 in order to study their medical condition showed the presence of undiagnosed micro- and macrovascular diabetic complications, a large number of risk factors for their development and progression, insufficient level of preventive measures, low compliance of patients to their use. Conclusions. The situation can be improved by providing medical care to patients with diabetes mellitus according to the multidisciplinary principle in a structured team, which should be coordinated by primary care physician, working in close collaboration with specialists and providing high-quality preventive care and teaching patients self-control. In order to optimize the quality of medical care for patients with diabetes mellitus type 2, we have developed and implemented a schedule for monitoring the quality of diabetes care to patients in primary care health centres of Kyiv region