Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry

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Abstract


Aim. We analysed the main epidemiological characteristics of diabetes mellitus (DM) in the Russian Federation (prevalence, incidence, mortality and mean life span), degree of diabetes control, and prevalence of diabetic complications (retinopathy, nephropathy, and diabetic foot syndrome and macrovascular pathology) according to the federal DM registry.

Materials and methods. The database of the federal DM registry of 79 regions was included using the online system until 31.12.2016.

Results. TThe total number of patients with DM in the Russian Federation on 31.12.2016 was 4.348 million (2.97% of the population), comprising 4 million patients with DM2 (92%), 255,000 with type 1 diabetes (T1DM) (6%), and 75,000 with other types of DM (2%). DM prevalence per 100,000 population was as follows: T1DM, 164.19/100,000; type 2 diabetes (T2DM), 2637.17/100,000; and other types of DM, 50.62/100. The incidence per 100,000 population was as follows: T1DM, 16.15/100,000; T2DM, 154.9/100,000; and other types of DM, 8.65/100,000. Mortality per 100,000 population was as follows: T1DM, 2.1/100,000; T2DM, 60.29/100,000; and other types of DM, 0.57/100,000. Mortality decreased in patients with T1DM by 6.6% and with T2DM by 3.6%. Mean life span in patients with T1DM was 50.3 years for men and 58.5 years for women. Mean life span in patients with T2DM was 70.1 years for men and 75.5 years for women. Glycated haemoglobin A1c (HbA1c) levels in T1DM was <7% in 33.4%, 7%–7.9% in 28.3%, 8%–8.9% in 16.2%, and ≥9.0% in 22.1% of patients. HbA1c levels in T2DM was <7% in 52.1%, 7%–7.9% in 29.1%, 8%–8.9% in 10%, and ≥9.0% in 8.7% of patients.

Conclusions. This study evaluated the increase in DM prevalence in the Russian Federation in 2016 and in the dynamics of 2013–2016, which was mainly due to T2DM. An increase in patients with a target HbA1c level <7% and a decrease in the proportion of patients with severe uncontrolled DM was observed; however, the treatment effectiveness of this key indicator was unsatisfactory, i.e. less than a third of the patients with DM. In the dynamics of 2013–2016, an increase in mean life span for patients with T2DM and mortality reduction in patients with T1DM and T2DM was observed. The frequency of diabetic complications varied widely, which may reflect differences in the quality of specialised care in different regions.


Diabetes mellitus (DM) is a chronic non-infectious disease, and its prevalence has reached global epidemic [1–4]. The enormous economic costs and social damage associated with the increase in the prevalence of DM and diabetic complications, high disability rate and mortality of this disease, led to the adoption of the United Nations (UN) Resolution in 2006 that declared a worldwide threat of DM and called for the development of national programmes on prevention, treatment and prophylaxis of diabetes and its complications.

Under these conditions, the organisation of a system for recording and monitoring DM indicators became a priority for the first order of national health systems. Thus, the development of the structure of the DM registry, which is a key source of epidemiological data, assumed national significance.

In the Russian Federation, clinical and epidemiological monitoring of DM has been performed since 1996 through the State Registry of DM Patients (SRDP), which is a methodological and organisational reference centre in the Federal State Budgetary Institution Endocrinology Research Centre of the Ministry of Health of Russia [5]. The SRDP was created by the Order of the Ministry of Health of the Russian Federation No. 404 on 10 December 1996 within the framework of the Federal Target Programme ‘Diabetes Mellitus.’ Over a 20-year period, the work of the registry played a key role in assessing the prevalence of DM and diabetic complications in the Russian Federation [6]. However, until recently, data analysis was conducted statically, representing a single-step cross-section for the period of the end of the calendar year based on the summation of databases of individual subjects in the Russian Federation.

Currently, the name of the SRDP has been transformed into a single federal database with authorised online access, which does not require the transfer of databases of regional registry segments. A distinctive feature of the modern registry is the possibility of online data entry and dynamic monitoring of indicators at any level, from an individual institution to a district, region and the Russian Federation as a whole. In addition, a new format of the registry enables system control of important parameters such as regulation of updating information and the quality of the data entered, including monitoring duplicates, entry of erroneous social and demographic characteristics, and therapies that do not meet the modern standards.

The purpose of the new registry system is to increase the efficiency of work as a key scientific and analytical platform to implement organisational and management decisions for the development and improvement of diabetes care in the Russian Federation.

Materials and Methods

The focus of the study was the database of the Federal DM Registry, comprising 79 regions of the Russian Federation included in the online registry system on 31 December 2016 (Fig. 1). The total number of DM patients in the Russian Federation was calculated using data from the Federal State Statistics Service (Rosstat) [7] on the number of DM patients in six regions that do not use online registry system.

 

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Fig. 1 Regions of the Russian Federation included in the system of the online DM registry as at 31.12.2016

 

Results

Analysis of prevalence of DM in the Russian Federation

The total number of DM patients in the Russian Federation (85 regions, taking into account six regions according to the Rosstat) on 31 December 2016, was 4.348 million (3% of the Russian Federation population), including: type 2 DM (T2DM) (92%; 4,001,860 people), type 1 DM (T1DM) (6%; 255,385 people), and other types of DM (2%; 75,123 people). In 16,054 patients, the type of DM was not indicated in the database (Fig. 2).

 

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Fig. 2 Total number of DM patients according to the data of the DM registry of the Russian Federation for the period 2000–2016

 

Thus, there has been a stable increase in the prevalence of DM in the Russian Federation, with an increase of 569,000 patients compared with 3.779 million as at 31 December 2012 [6], and an increase of 254 thousand compared with 4094 million patients as at 01/01/2015 [8].

The prevalence rate of DM by age group is presented according to the online registry in 79 regions of the Russian Federation (Table 1). Relevant data on DM prevalence in each of the 79 regions are presented in Appendix 1, Tables 1–4, all age groups: children, adolescents and adults, respectively (published as an online application).

 

Table 1. Indicators of DM prevalence in different age groups in 79 regions, as at 31 December 2016

79 regions of the
Russian Federation

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of DM

Total

T1DM

T2DM

Other types of DM

Total

227 514

3 654 182

70 142

3 951 838

164,19

2637,17

50,62

Children

20 468

1261

235

21 964

86,73

5,34

1,00

Adolescents

7748

260

100

8108

203,29

6,82

2,62

Adults

199 298

3 652 661

69 807

3 921 766

179,30

3286,13

62,80

 

The prevalence of DM per 100,000 of the population in different age groups.

Total of all age groups:

T1DM: 164.19 per 100,000 of the population;

T2DM: 2637.17 per 100,000 of the population;

Other types of DM: 50.62 per 100,000 of the population.

There was an increase in the prevalence of DM per 100,000 of the population compared with the data from 2015: T1DM increased from 157.4 to 164.19 per 100,000 of the population, and T2DM increased from 2518.3 to 2637.17 per 100,000 of the population.

In the paediatric age group:

T1DM: 86.73 per 100,000 children;

T2DM: 5.34 per 100,000 children;

Other types of DM: 1.0 per 100,000 children.

There was an increase in the prevalence of T1DM per 100,000 children compared with the data from 2015, from 70.2 to 86.73 per 100,000 children.

In the adolescent age group:

T1DM: 203.29 per 100,000 adolescents;

T2DM: 6.82 per 100,000 adolescents;

Other types of DM: 2.62 per 100,000 adolescents.

There was an increase in the prevalence rate of T1DM per 100,000 adolescents compared with the data from 2015, from 164.1 to 203.29 per 100,000 adolescents. A high prevalence of T2DM among children and adolescents persists (5.3 and 6.8 per 100,000, respectively). This dangerous tendency may result from the high prevalence of overweight and obesity, not only in adults, but also in children and adolescents.

In the adult age group:

T1DM: 179.3 per 100,000 adults;

T2DM: 3286.6 per 100,000 adults;

Other types of DM: 62.8 per 100,000 adults.

In the adult age group, an increase in the prevalence of all types of DM was noted compared with the data from 2015: T1DM increased from 175.2 to 179.3 per 100,000 adults, T2DM increased from 3125.6 to 3286.6 per 100,000 adults, and other types of DM increased from 55.2 to 62.8 per 100,000 adults.

The dynamics of the prevalence of T1DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation (Fig. 3).

 

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Fig. 3 Dynamics of prevalence of T1DM and T2DM from 2013–2016 in 79 regions of the Russian Federation

 

The primary increase in the prevalence of DM is due to T2DM, which reflects the global tendency in the increase in the proportion of T2DM among the total number of DM patients.

Despite a decrease in the dynamics of growth of T2DM in 2016 (+1.2%) compared with 2014–2015 (+4.7 and 2.8%, respectively), it is too early to regard this as a sign of a stop in the growth rate. This can be explained by the active work to identify duplicated patients in the registry database (in 2016 more than 80,000 duplicates were removed). However, the marked deterioration in the detection of new cases of T2DM in recent years is the most significant, and is confirmed by data on the reduction of the incidence rate registered (Fig. 4). Thus, the results of a large-scale National Epidemiological Study (NATION) showed that fewer than 50% of patients with T2DM are diagnosed in routine clinical practice. According to this study, the actual prevalence of T2DM in the adult population of Russia is 5.4% of the population, of which more than half (2.9%) accounts for previously unidentified T2DM that was only detected during the study (20% of the glycated hemogloblin (HbA1c) values at the time of diagnosis exceeded 9% [9]). This constitutes an extreme threat for the long-term prognosis of such patients who are not monitored by a doctor, receive no treatment, and therefore have a high risk of development of vascular complications. The NATION results again underscore the necessity to develop government programmes aimed at active screening of T2DM in the population, especially in at-risk groups.

Unlike the increase in prevalence of T2DM, the dynamics of T1DM can be regarded as having plateaued. In terms of prevalence per 100,000 of the population, the prevalence rate of T1DM in all age groups is registered, which again confirms the relative nature of this tendency.

Analysis of incidence of dm in the russian federation

The incidence rates of DM in different age groups are presented according to the online registry in 79 regions of the Russian Federation (Table 2). The indicators of the incidence of DM in each of the 79 regions of the Russian Federation are presented in Appendix 2, Table 1 (published as an online application).

 

Table 2. Indicators of the incidence of DM in different age groups in 79 regions, as at 12/31/2016

79 regions of the
Russian Federation

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of DM

Total

T1DM

T2DM

Other types of DM

Total

8516

214 668

11 989

235 173

6,15

154,92

8,65

Children

2780

358

56

3194

11,78

1,52

0,24

Adolescents

306

35

18

359

8,03

0,92

0,47

Adults

5430

214 275

11 915

231 620

4,89

192,77

10,72

 

In 79 regions of the Russian Federation in 2016, 235,173 new cases of DM were registered: 8516 patients with T1DM (3.6%), 214,668 patients with T2DM (91.3%), and 11,989 patients with other types of DM (5.1%), In terms of morbidity per 100,000 people, this amounted to:

T1DM: 6.15 per 100,000 of the population;

T2DM: 154.9 per 100,000 of the population;

Other types of diabetes: 8.65 per 100,000 of the population.

Compared with the data of 2015, this was:

T1DM: 6.2 per 100,000 of the population;

T2DM: 152.7 per 100,000 of the population;

Other types of diabetes: 7.2 per 100,000 of the population.

There was an increase in the incidence of DM per 100,000 of the population in 2016, which was most pronounced for T2DM.

Dynamics of the incidence of T1DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation (Fig. 4).

 

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Fig. 4 Dynamics of incidence of T1DM and T2DM from 2013–2016 in 79 regions of the Russian Federation

 

When evaluating indicators in dynamics, the continuing decrease in the incidence in absolute values of both T1DM and T2DM becomes evident (Fig. 4). Analysing the cause of this phenomenon does not indicate a true decrease in incidence of DM. The main reasons are the decline of active screening and detection of DM, which is typical for T2DM [9], as well as improper registration of new cases of DM in the registry database. The lack of attention to the registry management in a number of regions is reflected in the artificial lowering of the incidence of DM in the Russian Federation as a whole. This is confirmed by the considerable variability of the indicator in some regions, which cannot be explained by geographical or ethnic differences (especially in relation to T2DM).

ТThus, in 2016, the incidence of T1DM varied from 12.86 in the Republic of Karelia and 12.1 in the Republic of Tatarstan, which is two times higher than the average values in the Russian Federation, to 0 in the Republic of Tuva, Saratov Region, Nenets Autonomous Area and the Irkutsk Region, where no new cases of T1DM were registered (Appendix 2, Table 1). T2DM had a similar tendency: the incidence rates ranged from 289.8 in the Kirov region and 289.3 in the Altai Territory, which is 1.9 times higher than the average values for T2DM in the Russian Federation, to 0 in the same regions where no T1DM was registered, i.e. the Republic of Tuva, the Saratov Region, the Nenets Autonomous Area and the Irkutsk Region (Appendix 2, Table 1).

Analysis of mortality in patients with diabetes mellitus in the russian federation.

The mortality rates for DM in different age groups are presented according to the online registry in 79 regions of the Russian Federation (Table 3). The corresponding indicators for each of the 79 regions are presented in Appendix 3, Table 1 (published as an online application).

 

Table 3. Mortality rates for DM in different age groups in the 79 regions, as at 12/31/2016

79 regions of the
Russian Federation

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of DM

Total

T1DM

T2DM

Other types of DM

Total

2 964

84 867

823

88 654

2,22

63,66

0,62

Children

11

8

1

20

0,05

0,03

0

Adolescents

4

1

0

5

0,10

0,03

0

Adults

2 949

84 858

822

88 629

2,66

76,35

0,74

 

In the 79 regions of the Russian Federation in 2016, 87,244 DM patients’ deaths were registered: 2906 T1DM patients (3.3%), 83,542 T2DM patients (95.8%), 796 patients with other types of DM (0.9%), which in terms of mortality per 100,000 people was as follows:

T1DM: 2.1 per 100,000 of the population;

T2DM: 60.29 per 100,000 of the population;

Other types of DM: 0.57 per 100,000 of the population.

The dynamics of mortality in patients with T1DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation (Fig. 5).

 

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Fig. 5 Dynamics of mortality in patients with T1DM and T2DM in 79 regions of the Russian Federation, 2013–2016

 

When analysing the dynamics of indicators from 2013–2016, for the first time in the last four years, a decrease in mortality was registered for both T1DM (by 6.6%) and T2DM (by 3.6%) (Fig. 5).

The structure of mortality (Fig. 6).

 

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Fig. 6 Structure of mortality of patients with DM in 79 regions of the Russian Federation as at 12/31/16

 

According to the data for 2016, cardiovascular pathology continued be the leading cause of death of patients with DM, for both types of DM. Total chronic cardiovascular insufficiency, cerebrovascular disturbances, myocardial infarction and acute cardiovascular disorders were the cause of death of 31.9% patients with T1DM and 49.5% of patients with T2DM. Unknown cause of death was excluded from the analysis (36.9% for T1DM and 29.8% for T2DM); however, the proportion of cardiovascular complications in the structure of mortality of patients with DM increased even more significantly, up to 47% for T1DM and 67% for T2DM (Figs. 7 and 8, respectively), confirming the importance of early diagnosis and therapeutic approaches aimed at correcting cardiovascular risk in DM patients. The second highest cause of death for patients with T2DM was oncological pathology (10.0%), and its share in the mortality structure continues to grow (in 2015 it was 8.42%), and for T1DM, this was terminal renal insufficiency (7.1%). In T1DM, a higher percentage of severe complications was noted, such as diabetic complications (2.7%), hypoglycaemia (1.8%), coma, sepsis (1.8%) and gangrene (1.2%), compared with T2DM (0.4%, 0.1%, 0.4%, 0.7%, respectively) which, along with the poorest indicators of carbohydrate metabolism control (Fig. 11), explains the significantly lower life expectancy values for this disease.

 

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Fig. 7 Dynamics of established causes of death in T1DM, 2013–2016 (as at 12/31/16)

 

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Fig. 8 The dynamics of established causes of death in T2DM, 2013–2016. (as at 12/31/16)

 

Analysis of life expectancy in patients with diabetes mellitus in the russian federation

Life expectancy of patients with T2DM and T2DM from 2013–2016 according to the online registry in 79 regions of the Russian Federation is shown in Figs. 9 and 10.

In the dynamics of life expectancy indicators, significant differences in patients with T1DM and T2DM were noted. For T2DM, there was a steady positive dynamic towards an increase in life expectancy in the period 2013–2016 from 69.7 to 70.1 years in men, and 74.9 to 75.5 years in women (Fig. 10), whose life expectancy exceeds the average values in the population of the Russian Federation. The life expectancy of men with T1DM can be regarded as stable with a tendency to increase from 49.6 to 50.3 years, while in women, a negative dynamic with a decrease in life expectancy from 59.4 to 58.5 years was noted over the four years (Fig. 9).

 

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Fig. 9 Dynamics of life expectancy of patients with T1DM in 79 regions of the Russian Federation, 2013–2016

 

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Fig. 10 Dynamics of life expectancy of patients with T2DM in 79 regions of the Russian Federation, 2013–2016

 

These data differ from those obtained in the period 2007–2012, indicating a significant increase in life expectancy for both T2DM and T1DM [6] that requires further analysis and interpretation. Nevertheless, it is obvious that significantly poorer indicators of carbohydrate metabolism control (77% of patients with T1DM did not reach the target HbA1c levels) and a higher mortality rate due to coma, gangrene and sepsis, which are the complications associated with unsatisfactory metabolic control, are significant factors for these negative tendencies.

Analysis of the state of carbohydrate metabolism compensation (HbA1C level)

The distribution of patients by HbA1c level in the dynamics of 2013–2016 (Fig. 11) is presented according to the online registry for 76 regions of the Russian Federation (in three regions—the Irkutsk Region, the Nenets Autonomous Area and the Republic of Tuva—the indicator was not entered in the registry, and the Saint Petersburg region was not included in the analysis due to the incomplete database in the online registry).

 

8664-15468-1-SP.png

Fig. 11 Distribution of patients by level of HbA1c in the dynamics of 2013–2016

 

In the period 2013–2016 there was a persistent tendency to improve carbohydrate metabolism in both types of DM, for example, an increased number of patients with a target HbA1c level <7% to 52.1% for T2DM and 33.4% for T1DM, and a decreased number of patients with severe decompensation of DM with an HbA1c level ≥9.0%, up to 8.7% for T2DM and 22.1% for T1DM. However, the possibility of direct extrapolation of these data to the general population of DM patients in the Russian Federation is limited, since less than one-third of patients entered into the registry had HbA1c examined, that is, 32.5% with T1DM and 29.3% with T2DM.

General tendencies do not always reflect the real situation and requires targeted assessment of the dynamics in a particular region. This is confirmed by a very high variability of HbA1c, depending on the region for both T1DM (Fig. 12) and T2DM (Fig. 13).

 

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Fig. 12 Distribution of T1DM patients according to HbA1c level, 2016

 

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Fig. 13 Distribution of T2DM patients according to HbA1c level, 2016

 

Control of HbA1c requires monitoring in DM patients, both clinically, to assess the effectiveness of hypoglycaemic therapy and timely decision-making on the need for its intensification, and organisational, as a target indicator of the quality of diabetes care. For this purpose, it is necessary not only to improve the quality of HbA1c data entry into the registry (in 100% of patients), but also, first of all, to increase the availability of HbA1c measurement, regardless of the patient’s place of residence, and increase the frequency of measurement.

The frequency of measuring HbA1c level is important for DM patients, and is determined by the provision of algorithms for specialised medical care for DM patients, and is required once every 3 months [10].

Analysis of prevalence of complications

The distribution of the frequency of diabetic complications in T1DM and T2DM according to 78 regions of the Russian Federation (the region of Saint Petersburg was not included in the analysis of complications due to an incomplete online database) is shown in Fig. 14.

 

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Fig. 14 Distribution of incidence of complications with T1DM and T2DM in 78 regions of the Russian Federation, 2016

 

  • In T1DM, diabetic neuropathy was recorded in 33.6%, diabetic retinopathy in 27.2%, nephropathy in 20.1%, hypertension in 17.1%, diabetic macroangiopathy in 12.1%, diabetic foot syndrome in 4.3%, ischaemic heart disease (CHD) in 3.5%, cerebrovascular disorders in 1.5%, and myocardial infarction in 1.1% of patients.
  • In T2DM, hypertension was most frequently recorded in 40.6%, diabetic neuropathy in 18.6%, diabetic retinopathy in 13.0%, ischaemic heart disease (CHD) in 11.0%, diabetic nephropathy in 6.3%, macroangiopathy in 6.0%, cerebrovascular disorders in 4.0%, myocardial infarction in 3.3%, and diabetic foot syndrome in 2.0% of patients.

When analysing the prevalence of diabetic complications, it was found that, according to the registry, the incidence of complications was significantly lower than according to the studies with active screening [11–12], including those obtained by examining patients in the mobile diagnostic and treatment module of the Diabetes Centre of Federal State Budgetary Institution Endocrinology Research Centre [6].

These differences are, of course, affected by the objective features of the registry’s operation, where data are recorded by appealability, i.e. only identified cases of DM and complications, which can underestimate the level of their prevalence.

Nevertheless, it is difficult to explain the significant variability in the frequency of complications by other causes, except for differences in the quality of diabetes care and insufficient attention to registry management in a number of regions.

The key factor determining the recorded incidence of complications is availability of specialised diabetes care at the primary level, namely, the presence of retinopathy rooms, treatment rooms for diabetic foot, and the availability of cardiology functional diagnostics in the region. Thus, a low incidence of complications (as good as 0% in a number of regions) may indicate an absence or inefficiency of these structures in the region, as well as non-compliance with key standards for the examination of target organs in DM patients no less than once per year and more often for at-risk groups.

This is especially important for diagnosing the initial reversible stage of complications which does not cause vivid clinical symptoms and complaints in the patient. The initial stages of diabetic complications can be effectively detected only through active appointment to specialised professionals (ophthalmologist, podiatrist) and regular performance of screening for microalbuminuria and assessment of glomerular filtration rate in all DM patients (at least once per year) [10], which is often not performed in routine clinical practice.

It should be emphasised that in many regions, in patients with T2DM, a lower incidence of not only microvascular (retinopathy, nephropathy) but also macrovascular complications was recorded, as well as diabetic foot syndrome. This cannot highlight the real situation, given the many additional factors of target organ damage in DM2, such as old age, a longer history of concomitant hypertension, dyslipidaemia, and a higher incidence of obesity. It is important to note that the actual incidence of complications in T2DM is seriously underestimated in the existing system of diabetes care [13]. Unlike patients with T1DM who are historically perceived as a high-risk cohort requiring more frequent examination, patients with T2DM often remain beyond the field of view of endocrinologists. This poses a serious threat both in terms of late diagnostics of pathology at pronounced stages, when efficiency of treatment is much lower, and in to significantly larger extent of social and economic damage, given the prevalence of patients with T2DM [14].

Since 2016, the online registry system has introduced a function of automated reports that enable the incidence and quarterly dynamics of diabetic complications to be estimated, including those detected for the first time and, crucially important, indicating the stage at the time of diagnosis. The report can be performed both for the region as a whole, and for each health facility, which enables the efficiency of their work to be evaluated. From this point of view, the registry becomes a key indicator of the quality of rendering specialised care that enables the efficiency of diabetes services in the regions to be monitored.

Diabetic nephropathy

Diabetic nephropathy was recorded in 20.1% of patients with T1DM and 6.3% of patients with T2DM.

The incidence of nephropathy ranged widely from 0.1% (the Republic of Kabardino-Balkaria) to 40.7% (the Saratov Region) in T1DM (Fig. 15), and from 0% (Republic of Kabardino-Balkaria) to 19, 9% (Altai Territory) in T2DM (Fig. 16).

 

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Fig. 15 Prevalence of diabetic nephropathy in T1DM in 78 regions of the Russian Federation, 2016

 

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Fig. 16 Prevalence of diabetic nephropathy in T2DM in 78 regions of the Russian Federation, 2016

 

Diabetic retinopathy

Diabetic retinopathy was recorded in 27.2% of patients with T1DM and 13.0% of patients with T2DM.

The incidence rate of diabetic retinopathy ranged from 0.1% (the Republic of Kabardino-Balkaria) to 57% (Chuvash Republic) in T1DM (Fig. 17), and from 0.1% (the Republic of Kabardino-Balkaria) to 35.9% (Kursk Region) (Fig. 18) in T2DM.

 

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Fig. 17 Prevalence of diabetic retinopathy in T1DM in 78 regions of the Russian Federation, 2016

 

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Fig. 18 Prevalence of diabetic retinopathy in T2DM in 78 regions of the Russian Federation, 2016

 

Diabetic neuropathy

Diabetic neuropathy was recorded in 33.6% of patients with T1DM and 18.6% of patients with T2DM.

The incidence rate of neuropathy ranged from 0.1% (the Republic of Kabardino-Balkaria) to 67.2% (Tambov Region) (Fig. 19) in T1DM, and from 0.1% (the Republic of Kabardino-Balkaria) to 42.4% (Kursk Region) (Fig. 20) in T2DM.

 

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Fig. 19 Prevalence of diabetic neuropathy in T1DM in 78 regions of the Russian Federation, 2016

 

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Fig. 20 Prevalence of diabetic neuropathy in T2DM in 78 regions of the Russian Federation, 2016

 

Diabetic foot syndrome

Diabetic foot syndrome was recorded in 4.3% of patients with T1DM and 2% of patients with T2DM.

The incidence rate of diabetic foot syndrome ranged from 0% (the Republic of Kabardino-Balkaria) to 19.5% (Lipetsk Region) (Fig. 21) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 16.2% (the Republic of Altai) (Fig. 22) in T2DM.

 

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Fig. 21 Prevalence of diabetic foot syndrome in T1DM in 78 regions of the Russian Federation, 2016

 

 

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Fig. 22 Prevalence of diabetic foot syndrome in T2DM in 78 regions of the Russian Federation, 2016  

 

Diabetic macroangiopathy

Diabetic macroangiopathy was recorded in 12.1% of patients with T1DM and 6% of patients with T2DM.

The incidence rate of macroangiopathy ranged from 0% (Sverdlovsk Region) to 35.1% (Magadan Region) (Fig. 23) in T1DM, and from 0% (the Republic of North Ossetia-Alania) to 20.6% (Kursk Region) (Fig. 24) in T2DM.

 

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Fig. 23 Prevalence of diabetic macroangiopathy in T1DM in 78 regions of the Russian Federation, 2016

 

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Fig. 24 Prevalence of diabetic macroangiopathy in T2DM in 78 regions of the Russian Federation, 2016

 

Arterial hypertension

Arterial hypertension was registered in 17.1% of patients with T1DM and 40.6% of patients with T2DM.

The incidence rate of hypertension ranged from 0% (the Republic of Kabardino-Balkaria) to 45.1% (Tambov Region) (Fig. 25) in T1DM, and from 0.1% (the Republic of Kabardino-Balkaria) to 88.7% (Altai Territory) (Fig. 26) in T2DM.

 

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Fig. 25 Prevalence of arterial hypertension in T1DM in 78 regions of the Russian Federation, 2016

 

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Fig. 26 Prevalence of arterial hypertension in T2DM in 78 regions of the Russian Federation, 2016

 

Ischaemic heart disease

Ischaemic heart disease was registered in 3.5% of patients with T1DM and in 11.0% of patients with T2DM.

The incidence rate of ischaemic heart disease ranged from 0% (Nenets Autonomous Area) to 19.1% (Oryol Region) (Fig. 27) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 29.4% (Kaliningrad Region) (Fig. 28) in T2DM.

 

8664-15484-1-SP.png

Fig. 27 Prevalence of ischaemic heart disease in T1DM in 78 regions of the Russian Federation, 2016

 

8664-15485-1-SP.png

Fig. 28 Prevalence of ischaemic heart disease in T2DM in 78 regions of the Russian Federation, 2016

 

Myocardial infarction

Myocardial infarction was recorded in 1.1% of patients with T1DM and 3.3% of patients with T2DM.

The incidence rate of myocardial infarction ranged from 0% (the Republic of Kabardino-Balkaria) to 3.1% (Leningrad Region) (Fig. 29) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 10.2% (the Republic of Altai) (Fig. 30) in T2DM.

 

8664-15486-1-SP.png

Fig. 29 Prevalence of myocardial infarction in T1DM in 78 regions of the Russian Federation, 2016

 

8664-15487-1-SP.png

Fig. 30 Prevalence of myocardial infarction in T2DM in 78 regions of the Russian Federation, 2016

 

Cerebrovascular diseases

Cerebrovascular diseases were recorded in 1.5% of patients with T1DM and 4.0% of patients with T2DM.

The incidence rate of cerebrovascular diseases ranged from 0% (Republic of North Ossetia-Alania) to 4.6% (Lipetsk Region) (Fig. 31) in T1DM, and from 0% (the Republic of Kabardino-Balkaria) to 11.5% (the Republic of Altai) (Fig. 32) in T2DM.

 

8664-15488-1-SP.png

Fig. 31 Prevalence of cerebrovascular diseases in T1DM in78 regions of the Russian Federation, 2016

 

8664-15489-1-SP.png

Fig. 32 Prevalence of cerebrovascular diseases in T2DM in 78 regions of the Russian Federation, 2016

 

Conclusion

In assessing the data of the DM registry, the year 2016 became the focus since most of the regions of the Russian Federation transferred to the online format, which is a fundamentally new system of approach to registry management based on the creation of a dynamic database that enables multilevel monitoring of key clinical and epidemiological indicators.

In the Russian Federation in 2016 and from 2013–2016, the prevalence of DM grew persistently, mainly due to T2DM. There was a significant increase in the number of patients achieving a target HbA1c level of <7%, as well as a decrease in the proportion of patients with severe DM decompensation with HbA1c ≥9.0%; however, the frequency of measurement of this key indicator of treatment efficiency is unsatisfactory, as it was measured in less than a third of DM patients. This requires action to increase the availability of HbA1c monitoring. In the dynamics for the period 2013–2016, an increased life expectancy for patients with T2DM and a reduction in mortality in both types of DM was noted. The incidence of diabetic complications varied widely from region to region, which may reflect to a greater extent the differences in the quality of specialised primary care rather than geographical or ethnic determinants.

The new online registry system is a highly functional information and analytical platform with broad analysis capabilities, which can be used by health authorities as a key tool for assessing the current status, and planning and optimising the diabetes care in certain regions and in the Russian Federation as a whole.

Additional information

Financing of the work

The work was performed within the framework of the state task of the Ministry of Health of the Russian Federation No. АААА-А16-116011100138-5.

Conflict of interest

The authors declare the absence of obvious and potential conflicts of interest related to the publication of this article.

Participation of authors

Shestakova M.V., Vikulova O.K. - analysis and interpretation of the study results, writing an article; Dedov I.I. - final analysis of the results and editing of the manuscript text.

Благодарности:

ЗАО «Астон Консалтинг» за техническое сопровождение регистра СД в онлайн-формате.

Всем медицинским специалистам (врачам, медицинским сестрам, регистраторам данных), ведущим активную работу по заполнению базы данных регистра СД.

 

Appendix 1

Table 1. PREVALENCE OF DIABETES MELLITUS IN ALL AGE GROUPS ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Region

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of diabetes

Total

T1DM

T2DM

Other types of diabetes

Total

Russian Federation 79 regions

227 514

3 654 182

70 142

3 951 838

164.19

2637.17

50.62

2851.98

Adygea Republic

808

12 692

404

13 904

178.97

2811.20

89.48

3079.65

Altai Republic

293

3780

160

4233

136.18

1756.82

74.36

1967.36

Altai Territory

4049

83 920

2357

90 326

170.36

3530.84

99.17

3800.36

Amur Region

1006

22 200

1091

24 297

124.86

2755.41

135.41

3015.68

Arkhangelsk Region

2341

38 143

5594

46 078

207.12

3374.77

494.94

4076.83

Astrakhan Region

1485

28 334

792

30 611

145.78

2781.59

77.75

3005.13

Bashkortostan Republic

6544

96 024

75

102 643

160.74

2358.70

1.84

2521.28

Belgorod Region

2727

47 041

614

50 382

175.92

3034.64

39.61

3250.16

Bryansk Region

2473

40 730

234

43 437

201.76

3322.89

19.09

3543.73

Buryat Republic

808

28 127

152

29 087

82.26

2863.43

15.47

2961.16

Vladimir Region

2126

46 000

300

48 426

152.16

3292.37

21.47

3466.01

Volgograd Region

3780

73 855

376

78 011

148.47

2900.90

14.77

3064.14

Vologda Region

5149

32 001

677

37 827

433.53

2694.40

57.00

3184.94

Voronezh Region

4666

70 528

9677

84 871

199.96

3022.44

414.70

3637.10

Dagestan Republic

301

5379

80

5760

9.98

178.37

2.65

191.00

Jewish Autonomous Oblast

308

4829

9

5146

185.41

2906.93

5.42

3097.76

Zabaykalsky Krai

2186

25 426

484

28096

201.84

2347.71

44.69

2594.25

Ivanovo Region

1907

38 353

1803

42063

185.17

3724.18

175.08

4084.43

Ingush Republic

278

6273

49

6600

58.80

1326.84

10.36

1396.01

Irkutsk Region

2992

62 240

830

66 062

124.01

2579.58

34.40

2737.98

Kabardino-Balkar Republic

626

4750

1

5377

72.60

550.88

0.12

623.60

Kaliningrad Region

1630

23 909

193

25732

166.93

2448.59

19.77

2635.29

Republic of Kalmykia

322

8008

289

8619

115.52

2873.00

103.68

3092.21

Kaluga Region

1789

29 289

174

31 252

177.17

2900.56

17.23

3094.96

Kamchatka Krai

328

7903

92

8323

103.76

2500.03

29.10

2632.89

Karachai-Cherkess Republic

751

10 109

122

10 982

160.54

2160.98

26.08

2347.60

Republic of Karelia

1699

24 742

1281

27 722

269.74

3928.08

203.37

4401.19

Kemerovo Region

3746

64 770

1057

69 573

137.84

2383.33

38.89

2560.06

Kirov Region

2081

45 033

4928

52 042

160.39

3470.82

379.81

4011.02

Republic of Komi

1528

27 104

3467

32 099

178.33

3163.28

404.63

3746.25

Kostroma Region

1322

17 876

48

19 246

202.93

2744.03

7.37

2954.33

Krasnodar Krai

8789

153 810

2223

164 822

159.40

2789.54

40.32

2989.26

Republic of Crimea

2931

26 200

163

29 294

153.69

1373.81

8.55

1536.04

Kurgan Region

1322

21 346

80

22 748

153.38

2476.63

9.28

2639.30

Kursk Region

2252

29 805

431

32 488

201.07

2661.12

38.48

2900.67

Leningrad Region

4994

37 041

66

42 101

280.74

2082.29

3.71

2366.74

Lipetsk Region

2921

32 128

132

35 181

252.66

2779.02

11.42

3043.09

Magadan Region

230

4499

60

4789

157.16

3074.24

41.00

3272.40

Mari El Republic

917

18 890

25

19 832

133.70

2754.19

3.65

2891.53

Republic of Mordovia

1401

22 046

7

23 454

173.51

2730.31

0.87

2904.69

Moscow

19 021

303 004

1152

323 177

154.26

2457.43

9.34

2621.04

Moscow Region

13 020

214 797

4393

232 210

177.90

2934.93

60.02

3172.85

Murmansk Region

1247

19 879

520

21646

163.61

2608.20

68.23

2840.04

Nenets Autonomous Area

143

1850

434

2427

326.20

4220.08

990.01

5536.29

Nizhny Novgorod Region

5515

119 466

4591

129 572

169.16

3664.30

140.82

3974.28

Novgorod Region

1281

15 285

47

16613

208.06

2482.57

7.63

2698.26

Novosibirsk Region

3932

79 296

2054

85 282

142.35

2870.72

74.36

3087.43

Omsk Region

3367

48 412

811

52 590

170.18

2446.95

40.99

2658.12

Orenburg Region

3954

59 556

894

64 404

198.22

2985.62

44.82

3228.66

Oryol Region

1628

22 537

147

24 312

214.29

2966.48

19.35

3200.12

Penza Region

2317

43 069

454

45 840

171.79

3193.36

33.66

3398.82

Perm Krai

4139

75 176

1431

80 746

157.11

2853.62

54.32

3065.05

Pskov Region

623

5881

28

6532

96.38

909.84

4.33

1010.56

Rostov Region

6060

121 352

355

127 767

143.06

2864.78

8.38

3016.22

Samara Region

4774

74 740

333

79 847

148.91

2331.27

10.39

2490.57

Saint Petersburg

10 706

128 687

3073

142 466

204.87

2462.58

58.81

2726.26

Saratov Region

3892

73 427

35

77 354

156.46

2951.80

1.41

3109.67

Republic of Sakha/Yakutia

1099

20 508

70

21 677

114.52

2136.94

7.29

2258.75

Sverdlovsk Region

8174

13 3095

382

141651

188.78

3073.78

8.82

3271.38

Sevastopol

212

265

4

481

50.93

63.66

0.96

115.55

Republic of North Ossetia-Alania

913

13 024

20

13957

129.73

1850.67

2.84

1983.25

Smolensk Region

2498

31 134

865

34 497

260.58

3247.76

90.23

3598.57

Stavropol Territory

3959

65 778

1683

71 420

141.31

2347.88

60.07

2549.26

Tambov Region

2691

41 704

787

45 182

256.21

3970.69

74.93

4301.84

Republic of Tatarstan

7529

109 066

471

117 066

194.61

2819.17

12.17

3025.95

Tver Region

2971

38 796

718

42 485

227.71

2973.46

55.03

3256.19

Tomsk Region

1232

28 206

223

29 661

114.42

2619.52

20.71

2754.65

Tula Region

2840

48 323

381

51 544

188.52

3207.75

25.29

3421.56

Republic of Tuva

238

1223

8

1469

75.40

387.47

2.53

465.41

Tyumen Region

2318

41 983

600

44 901

159.35

2886.17

41.25

3086.77

Ulyanovsk Region

1976

38 215

94

40 285

157.12

3038.67

7.47

3203.27

Khabarovsk Krai

1398

24 409

199

26 006

104.75

1829.00

14.91

1948.67

Republic of Khakassia

731

15 487

106

16 324

136.18

2885.16

19.75

3041.09

Khanty-Mansijsk Autonomous District - Yugra

2609

49 899

904

53 412

160.38

3067.39

55.57

3283.35

Chelyabinsk Region

5343

75 309

437

81 089

152.63

2151.25

12.48

2316.35

Chechen Republic

463

13 347

30

13 840

33.21

957.34

2.15

992.70

Chuvash Republic

1250

25 834

171

27 255

101.08

2089.07

13.83

2203.98

Yamalo-Nenets Autonomous District

921

13 627

581

15 129

172.44

2551.38

108.78

2832.59

Yaroslavl Region

2724

43 403

59

46 186

214.17

3412.42

4.64

3631.23

 

Table 2. PREVALENCE RATE OF DM IN THE PEDIATRIC AGE GROUP ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Region

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of diabetes

T1DM

T2DM

Other types of diabetes

Russian Federation 79 regions

20468

1261

235

86.73

5.34

1.00

Adygea Republic

42

8

3

52.12

9.93

3.72

Altai Republic

24

0

0

41.70

0.00

0.00

Altai Territory

410

14

3

97.59

3.33

0.71

Amur Region

123

0

2

80.50

0.00

1.31

Arkhangelsk Region

264

1

4

134.05

0.51

2.03

Astrakhan Region

165

11

1

85.85

5.72

0.52

Bashkortostan Republic

939

3

1

122.19

0.39

0.13

Belgorod Region

168

22

2

69.95

9.16

0.83

Bryansk Region

187

20

0

96.62

10.33

0.00

Buryat Republic

47

11

1

21.07

4.93

0.45

Vladimir Region

133

49

3

62.38

22.98

1.41

Volgograd Region

306

33

1

75.39

8.13

0.25

Vologda Region

282

28

1

133.71

13.28

0.47

Voronezh Region

398

25

24

119.54

7.51

7.21

Dagestan Republic

49

13

1

6.59

1.75

0.13

Jewish Autonomous Oblast

6

1

0

18.40

3.07

0.00

Zabaykalsky Krai

223

15

8

96.61

6.50

3.47

Ivanovo Region

160

4

0

102.35

2.56

0.00

Ingush Republic

41

38

0

30.71

28.47

0.00

Irkutsk Region

255

7

0

52.68

1.45

0.00

Kabardino-Balkar Republic

66

4

0

37.83

2.29

0.00

Kaliningrad Region

90

7

0

56.81

4.42

0.00

Republic of Kalmykia

15

1

0

26.01

1.73

0.00

Kaluga Region

162

1

0

105.15

0.65

0.00

Kamchatka Krai

57

0

0

103.65

0.00

0.00

Karachai-Cherkess Republic

30

8

1

32.75

8.73

1.09

Republic of Karelia

148

12

5

138.69

11.25

4.69

Kemerovo Region

429

0

4

86.36

0.00

0.81

Kirov Region

211

4

4

98.38

1.87

1.87

Republic of Komi

184

4

6

114.16

2.48

3.72

Kostroma Region

99

13

1

89.79

11.79

0.91

Krasnodar Krai

896

50

16

94.81

5.29

1.69

Republic of Crimea

165

65

1

52.42

20.65

0.32

Kurgan Region

117

9

0

75.68

5.82

0.00

Kursk Region

209

9

2

120.73

5.20

1.16

Leningrad Region

72

16

1

28.99

6.44

0.40

Lipetsk Region

116

18

1

64.02

9.93

0.55

Magadan Region

23

0

2

89.55

0.00

7.79

Mari El Republic

99

2

0

79.56

1.61

0.00

Republic of Mordovia

122

2

2

105.69

1.73

1.73

Moscow

2099

83

49

124.92

4.94

2.92

Moscow Region

1364

12

16

118.94

1.05

1.40

Murmansk Region

73

13

1

55.67

9.91

0.76

Nenets Autonomous Area

16

4

1

158.70

39.67

9.92

Nizhny Novgorod Region

559

3

3

111.39

0.60

0.60

Novgorod Region

99

4

0

99.39

4.02

0.00

Novosibirsk Region

485

9

8

103.43

1.92

1.71

Omsk Region

412

14

1

116.38

3.95

0.28

Orenburg Region

384

6

2

103.31

1.61

0.54

Oryol Region

23

6

0

19.99

5.22

0.00

Penza Region

195

0

1

98.21

0.00

0.50

Perm Krai

457

6

1

92.80

1.22

0.20

Pskov Region

51

3

0

51.81

3.05

0.00

Rostov Region

640

29

1

96.96

4.39

0.15

Samara Region

411

109

0

81.44

21.60

0.00

Saint Petersburg

1015

30

14

141.78

4.19

1.96

Saratov Region

345

14

0

89.74

3.64

0.00

Republic of Sakha/Yakutia

49

26

0

21.88

11.61

0.00

Sverdlovsk Region

696

25

3

90.57

3.25

0.39

Sevastopol

57

0

0

89.99

0.00

0.00

Republic of North Ossetia-Alania

144

19

0

104.35

13.77

0.00

Smolensk Region

44

66

2

31.71

47.57

1.44

Stavropol Territory

267

43

7

54.94

8.85

1.44

Tambov Region

148

2

0

101.56

1.37

0.00

Republic of Tatarstan

615

26

1

89.93

3.80

0.15

Tver Region

92

16

1

45.86

7.98

0.50

Tomsk Region

141

0

1

74.68

0.00

0.53

Tula Region

201

58

1

97.47

28.12

0.48

Republic of Tuva

0

0

0

0.00

0.00

0.00

Tyumen Region

349

8

2

121.33

2.78

0.70

Ulyanovsk Region

168

0

1

88.80

0.00

0.53

Khabarovsk Krai

178

8

1

77.89

3.50

0.44

Republic of Khakassia

14

0

0

12.87

0.00

0.00

Khanty-Mansijsk Autonomous District - Yugra

259

1

10

73.46

0.28

2.84

Chelyabinsk Region

376

52

5

60.21

8.33

0.80

Chechen Republic

52

4

0

11.41

0.88

0.00

Chuvash Republic

128

11

1

58.57

5.03

0.46

Yamalo-Nenets Autonomous District

98

4

0

81.40

3.32

0.00

Yaroslavl Region

232

19

0

116.00

9.50

0.00

 

Table 3. PREVALENCE RATE OF DM IN THE ADOLESCENT AGE GROUP ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Region

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of diabetes

T1DM

T2DM

Other types of diabetes

Russian Federation 79 regions

7748

260

100

203.29

6.82

2.62

Adygea Republic

18

0

0

131.65

0.00

0.00

Altai Republic

11

0

0

141.32

0.00

0.00

Altai Territory

165

3

1

249.75

4.54

1.51

Amur Region

40

3

3

163.84

12.29

12.29

Arkhangelsk Region

114

2

1

367.90

6.45

3.23

Astrakhan Region

49

1

4

174.65

3.56

14.26

Bashkortostan Republic

372

6

0

296.36

4.78

0.00

Belgorod Region

67

0

0

169.30

0.00

0.00

Bryansk Region

71

3

0

217.40

9.19

0.00

Buryat Republic

23

5

0

71.75

15.60

0.00

Vladimir Region

52

5

0

150.38

14.46

0.00

Volgograd Region

89

2

1

130.53

2.93

1.47

Vologda Region

105

9

2

332.51

28.50

6.33

Voronezh Region

169

3

9

292.22

5.19

15.56

Dagestan Republic

9

4

0

6.31

2.80

0.00

Jewish Autonomous Oblast

0

4

0

0.00

83.47

0.00

Zabaykalsky Krai

93

3

0

251.17

8.10

0.00

Ivanovo Region

63

0

0

257.12

0.00

0.00

Ingush Republic

16

1

0

66.41

4.15

0.00

Irkutsk Region

127

6

0

169.77

8.02

0.00

Kabardino-Balkar Republic

37

2

0

117.85

6.37

0.00

Kaliningrad Region

45

2

4

175.21

7.79

15.57

Republic of Kalmykia

9

2

0

99.55

22.12

0.00

Kaluga Region

62

4

0

252.00

16.26

0.00

Kamchatka Krai

20

0

0

220.36

0.00

0.00

Karachai-Cherkess Republic

13

2

0

80.18

12.34

0.00

Republic of Karelia

46

6

0

268.43

35.01

0.00

Kemerovo Region

164

1

4

212.58

1.30

5.18

Kirov Region

99

2

5

293.68

5.93

14.83

Republic of Komi

50

0

3

192.93

0.00

11.58

Kostroma Region

57

2

1

326.11

11.44

5.72

Krasnodar Krai

314

9

2

204.28

5.86

1.30

Republic of Crimea

56

9

0

118.22

19.00

0.00

Kurgan Region

43

0

0

174.27

0.00

0.00

Kursk Region

100

3

0

329.66

9.89

0.00

Leningrad Region

40

3

0

94.78

7.11

0.00

Lipetsk Region

59

3

0

196.31

9.98

0.00

Magadan Region

9

1

2

204.31

22.70

45.40

Mari El Republic

24

2

1

127.99

10.67

5.33

Republic of Mordovia

34

2

0

163.90

9.64

0.00

Moscow

837

22

12

286.17

7.52

4.10

Moscow Region

490

14

5

280.35

8.01

2.86

Murmansk Region

41

3

0

196.04

14.34

0.00

Nenets Autonomous Area

2

0

0

117.72

0.00

0.00

Nizhny Novgorod Region

204

4

1

250.01

4.90

1.23

Novgorod Region

34

1

0

220.24

6.48

0.00

Novosibirsk Region

166

8

4

244.30

11.77

5.89

Omsk Region

123

1

0

238.88

1.94

0.00

Orenburg Region

118

4

1

202.96

6.88

1.72

Oryol Region

15

2

1

75.47

10.06

5.03

Penza Region

79

0

0

234.42

0.00

0.00

Perm Krai

159

7

4

204.84

9.02

5.15

Pskov Region

21

1

0

132.48

6.31

0.00

Rostov Region

245

5

2

218.39

4.46

1.78

Samara Region

142

5

1

179.25

6.31

1.26

Saint Petersburg

349

8

4

329.07

7.54

3.77

Saratov Region

157

8

1

234.42

11.94

1.49

Republic of Sakha/Yakutia

29

2

1

78.36

5.40

2.70

Sverdlovsk Region

257

9

0

227.91

7.98

0.00

Sevastopol

18

0

2

191.90

0.00

21.32

Republic of North Ossetia-Alania

44

1

0

178.07

4.05

0.00

Smolensk Region

33

1

0

146.69

4.45

0.00

Stavropol Territory

120

12

5

141.15

14.11

5.88

Tambov Region

70

3

1

256.55

11.00

3.67

Republic of Tatarstan

220

7

0

196.28

6.25

0.00

Tver Region

43

0

1

131.93

0.00

3.07

Tomsk Region

59

0

0

193.11

0.00

0.00

Tula Region

90

3

0

254.93

8.50

0.00

Republic of Tuva

1

0

0

7.48

0.00

0.00

Tyumen Region

101

1

0

256.28

2.54

0.00

Ulyanovsk Region

77

2

0

243.28

6.32

0.00

Khabarovsk Krai

53

1

0

156.70

2.96

0.00

Republic of Khakassia

7

0

0

43.61

0.00

0.00

Khanty-Mansijsk Autonomous District - Yugra

99

3

7

185.96

5.64

13.15

Chelyabinsk Region

137

4

1

141.35

4.13

1.03

Chechen Republic

17

1

0

22.77

1.34

0.00

Chuvash Republic

51

1

2

143.88

2.82

5.64

Yamalo-Nenets Autonomous District

35

0

0

175.67

0.00

0.00

Yaroslavl Region

71

1

1

229.00

3.23

3.23

 

Table 4. PREVALENCE RATE OF DM IN THE ADULT AGE GROUP ACCORDING TO THE DATA OF THE ONLINE REGISTRY
IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Region

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of diabetes

T1DM

T2DM

Other types of diabetes

Russian Federation 79 regions

199 298

3 652 661

69 807

179.30

3286.13

62.80

Adygea Republic

748

12 684

401

209.39

3550.75

112.26

Altai Republic

258

3780

160

172.21

2523.01

106.79

Altai Territory

3474

83 903

2353

183.75

4437.96

124.46

Amur Region

843

22 197

1086

134.13

3531.83

172.80

Arkhangelsk Region

1963

38 140

5589

217.55

4226.90

619.41

Astrakhan Region

1271

28 322

787

159.20

3547.46

98.58

Bashkortostan Republic

5233

96 015

74

164.71

3022.14

2.33

Belgorod Region

2492

47 019

612

196.16

3701.17

48.17

Bryansk Region

2215

40 707

234

221.60

4072.61

23.41

Buryat Republic

738

28 111

151

101.49

3865.65

20.76

Vladimir Region

1941

45 946

297

168.87

3997.45

25.84

Volgograd Region

3385

73 820

374

163.38

3562.99

18.05

Vologda Region

4762

31 964

674

503.81

3381.73

71.31

Voronezh Region

4099

70 500

9644

210.99

3628.96

496.42

Dagestan Republic

243

5362

79

11.41

251.86

3.71

Jewish Autonomous Oblast

302

4824

9

234.61

3747.47

6.99

Zabaykalsky Krai

1870

25 408

476

229.40

3116.93

58.39

Ivanovo Region

1684

38 349

1803

198.35

4516.90

212.36

Ingush Republic

221

6234

49

70.11

1977.81

15.55

Irkutsk Region

2610

62 227

830

140.78

3356.55

44.77

Kabardino-Balkar Republic

523

4744

1

79.68

722.74

0.15

Kaliningrad Region

1495

23 900

189

188.68

3016.39

23.85

Republic of Kalmykia

298

8005

289

140.55

3775.50

136.30

Kaluga Region

1565

29 284

174

188.30

3523.50

20.94

Kamchatka Krai

251

7903

92

99.58

3135.54

36.50

Karachai-Cherkess Republic

708

10 099

121

196.68

2805.42

33.61

Republic of Karelia

1505

24 724

1276

297.42

4885.91

252.16

Kemerovo Region

3153

64 769

1049

147.08

3021.32

48.93

Kirov Region

1771

45 027

4919

168.78

4291.18

468.79

Republic of Komi

1294

27 100

3458

193.21

4046.39

516.33

Kostroma Region

1166

17 861

46

222.64

3410.44

8.78

Krasnodar Krai

7579

153 751

2205

171.66

3482.44

49.94

Republic of Crimea

2710

26 126

162

175.41

1691.01

10.49

Kurgan Region

1162

21 337

80

170.22

3125.70

11.72

Kursk Region

1943

29 793

429

211.99

3250.48

46.80

Leningrad Region

4882

37 022

65

328.03

2487.57

4.37

Lipetsk Region

2746

32 107

131

290.63

3398.17

13.86

Magadan Region

198

4498

56

170.31

3869.05

48.17

Mari El Republic

794

18 886

24

146.31

3480.14

4.42

Republic of Mordovia

1245

22 042

5

185.47

3283.59

0.74

Moscow

16 085

302 899

1091

155.30

2924.47

10.53

Moscow Region

11 166

214 771

4372

186.19

3581.28

72.90

Murmansk Region

1133

19 863

519

185.70

3255.58

85.06

Nenets Autonomous Area

125

1846

433

389.93

5758.49

1350.72

Nizhny Novgorod Region

4752

119 459

4587

177.52

4462.73

171.36

Novgorod Region

1148

15 280

47

229.30

3052.04

9.39

Novosibirsk Region

3281

79 279

2042

147.44

3562.51

91.76

Omsk Region

2832

48 397

810

180.04

3076.82

51.50

Orenburg Region

3452

59 546

891

220.59

3805.04

56.94

Oryol Region

1590

22 529

146

254.48

3605.82

23.37

Penza Region

2043

43 069

453

182.99

3857.65

40.57

Perm Krai

3523

75 163

1426

170.66

3641.03

69.08

Pskov Region

551

5877

28

103.55

1104.51

5.26

Rostov Region

5175

121 318

352

149.40

3502.51

10.16

Samara Region

4221

74 626

332

160.98

2846.06

12.66

Saint Petersburg

9342

128 649

3055

212.14

2921.38

69.37

Saratov Region

3390

73 405

34

166.49

3605.12

1.67

Republic of Sakha/Yakutia

1021

20 480

69

146.12

2931.01

9.87

Sverdlovsk Region

7221

133 061

379

209.38

3858.18

10.99

Sevastopol

137

265

2

39.88

77.14

0.58

Republic of North Ossetia-Alania

725

13 004

20

134.00

2403.55

3.70

Smolensk Region

2421

31 067

863

303.62

3896.14

108.23

Stavropol Territory

3572

65 723

1671

160.13

2946.40

74.91

Tambov Region

2473

41 699

786

281.89

4753.23

89.60

Republic of Tatarstan

6694

109 033

470

217.85

3548.36

15.30

Tver Region

2836

38 780

716

264.67

3619.10

66.82

Tomsk Region

1032

28 206

222

120.36

3289.65

25.89

Tula Region

2549

48 262

380

201.52

3815.43

30.04

Republic of Tuva

237

1223

8

118.77

612.88

4.01

Tyumen Region

1868

41 974

598

165.66

3722.48

53.03

Ulyanovsk Region

1731

38 213

93

166.96

3685.73

8.97

Khabarovsk Krai

1167

24 400

198

108.84

2275.70

18.47

Republic of Khakassia

710

15 487

106

172.36

3759.61

25.73

Khanty-Mansijsk Autonomous District - Yugra

2251

49 895

887

184.36

4086.54

72.65

Chelyabinsk Region

4830

75 253

431

173.79

2707.64

15.51

Chechen Republic

394

13 342

30

45.61

1544.65

3.47

Chuvash Republic

1071

25 822

168

108.99

2627.83

17.10

Yamalo-Nenets Autonomous District

788

13 623

581

200.11

3459.55

147.54

Yaroslavl Region

2421

43 383

58

232.59

4167.82

5.57

 

Appendix 2

Table 1. INCIDENCE RATE OF DM ACCORDING TO THE DATA OF THE ON-LINE REGISTRY IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Region

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of diabetes

Total

T1DM

T2DM

Other types of diabetes

Total

Russian Federation 79 regions

8516

214 668

11 989

235 173

6.15

154.92

8.65

169.72

Adygea Republic

18

382

39

439

3.99

84.61

8.64

97.24

Altai Republic

7

231

8

246

3.25

107.36

3.72

114.33

Altai Territory

229

6876

402

7507

9.63

289.30

16.91

315.85

Amur Region

54

1500

344

1898

6.70

186.18

42.70

235.57

Arkhangelsk Region

127

2998

1036

4161

11.24

265.25

91.66

368.15

Astrakhan Region

87

2353

128

2568

8.54

231.00

12.57

252.10

Bashkortostan Republic

320

8264

83

8667

7.86

202.99

2.04

212.89

Belgorod Region

86

3160

97

3343

5.55

203.85

6.26

215.66

Bryansk Region

75

3122

57

3254

6.12

254.70

4.65

265.47

Buryat Republic

26

2133

75

2234

2.65

217.15

7.64

227.43

Vladimir Region

59

2542

46

2647

4.22

181.94

3.29

189.45

Volgograd Region

149

4930

212

5291

5.85

193.64

8.33

207.82

Vologda Region

116

1526

108

1750

9.77

128.49

9.09

147.35

Voronezh Region

214

6405

1364

7983

9.17

274.48

58.45

342.11

Dagestan Republic

50

1003

13

1066

1.66

33.26

0.43

35.35

Jewish Autonomous Oblast

1

37

0

38

0.60

22.27

0.00

22.88

Zabaykalsky Krai

85

896

54

1035

7.85

82.73

4.99

95.57

Ivanovo Region

77

2945

266

3288

7.48

285.97

25.83

319.27

Ingush Republic

6

271

0

277

1.27

57.32

0.00

58.59

Irkutsk Region

0

0

0

0

0.00

0.00

0.00

0.00

Kabardino-Balkar Republic

22

471

0

493

2.55

54.62

0.00

57.18

Kaliningrad Region

9

462

3

474

0.92

47.31

0.31

48.54

Republic of Kalmykia

16

423

20

459

5.74

151.76

7.18

164.67

Kaluga Region

83

2106

9

2198

8.22

208.56

0.89

217.67

Kamchatka Krai

24

507

20

551

7.59

160.38

6.33

174.30

Karachai-Cherkess Republic

13

474

3

490

2.78

101.33

0.64

104.75

Republic of Karelia

81

1573

175

1829

12.86

249.73

27.78

290.38

Kemerovo Region

182

4768

392

5342

6.70

175.45

14.42

196.57

Kirov Region

94

3760

777

4631

7.24

289.79

59.89

356.92

Republic of Komi

69

2055

976

3100

8.05

239.84

113.91

361.80

Kostroma Region

48

977

8

1033

7.37

149.97

1.23

158.57

Krasnodar Krai

455

9969

386

10810

8.25

180.80

7.00

196.05

Republic of Crimea

99

1974

19

2092

5.19

103.51

1.00

109.70

Kurgan Region

53

2312

11

2376

6.15

268.25

1.28

275.67

Kursk Region

63

1836

37

1936

5.62

163.93

3.30

172.85

Leningrad Region

40

921

13

974

2.25

51.77

0.73

54.75

Lipetsk Region

64

1586

20

1670

5.54

137.19

1.73

144.45

Magadan Region

11

265

9

285

7.52

181.08

6.15

194.75

Mari El Republic

52

1563

7

1622

7.58

227.89

1.02

236.49

Republic of Mordovia

82

1627

6

1715

10.16

201.50

0.74

212.40

Moscow

548

15198

205

15951

4.44

123.26

1.66

129.37

Moscow Region

570

12068

763

13401

7.79

164.89

10.43

183.11

Murmansk Region

48

1072

70

1190

6.30

140.65

9.18

156.13

Nenets Autonomous Area

0

0

0

0

0.00

0.00

0.00

0.00

Nizhny Novgorod Region

291

7612

715

8618

8.93

233.48

21.93

264.33

Novgorod Region

43

899

7

949

6.98

146.01

1.14

154.14

Novosibirsk Region

187

3840

393

4420

6.77

139.02

14.23

160.02

Omsk Region

66

644

11

721

3.34

32.55

0.56

36.44

Orenburg Region

218

5054

111

5383

10.93

253.36

5.56

269.86

Oryol Region

10

472

10

492

1.32

62.13

1.32

64.76

Penza Region

116

3247

130

3493

8.60

240.75

9.64

258.99

Perm Krai

219

4972

560

5751

8.31

188.73

21.26

218.30

Pskov Region

38

351

1

390

5.88

54.30

0.15

60.34

Rostov Region

304

8573

72

8949

7.18

202.38

1.70

211.26

Samara Region

259

6443

113

6815

8.08

200.97

3.52

212.57

Saint Petersburg

123

2020

136

2279

2.35

38.66

2.60

43.61

Saratov Region

0

0

0

0

0.00

0.00

0.00

0.00

Republic of Sakha/Yakutia

16

1046

4

1066

1.67

108.99

0.42

111.08

Sverdlovsk Region

388

9713

172

10273

8.96

224.32

3.97

237.25

Sevastopol

6

13

0

19

1.44

3.12

0.00

4.56

Republic of North Ossetia-Alania

26

705

1

732

3.69

100.18

0.14

104.01

Smolensk Region

57

833

4

894

5.95

86.89

0.42

93.26

Stavropol Territory

75

2075

74

2224

2.68

74.06

2.64

79.38

Tambov Region

16

323

11

350

1.52

30.75

1.05

33.32

Republic of Tatarstan

468

7879

27

8374

12.10

203.66

0.70

216.45

Tver Region

40

1163

28

1231

3.07

89.14

2.15

94.35

Tomsk Region

60

1366

67

1493

5.57

126.86

6.22

138.66

Tula Region

43

1305

12

1360

2.85

86.63

0.80

90.28

Republic of Tuva

0

0

0

0

0.00

0.00

0.00

0.00

Tyumen Region

120

3170

151

3441

8.25

217.93

10.38

236.56

Ulyanovsk Region

67

2313

18

2398

5.33

183.92

1.43

190.68

Khabarovsk Krai

59

1193

43

1295

4.42

89.39

3.22

97.04

Republic of Khakassia

36

1328

10

1374

6.71

247.40

1.86

255.97

Khanty-Mansijsk Autonomous District - Yugra

137

3257

534

3928

8.42

200.21

32.83

241.46

Chelyabinsk Region

252

6562

202

7016

7.20

187.45

5.77

200.42

Chechen Republic

27

882

11

920

1.94

63.26

0.79

65.99

Chuvash Republic

61

1912

16

1989

4.93

154.61

1.29

160.84

Yamalo-Nenets Autonomous District

38

662

15

715

7.11

123.95

2.81

133.87

Yaroslavl Region

138

3300

69

3507

10.85

259.45

5.42

275.73

 

Appendix 3.

Table 1. MORTALITY IN DM ACCORDING TO THE DATA OF THE ONLINE REGISTRY IN 79 REGIONS OF THE RUSSIAN FEDERATION, 2016

Region

Number of patients

Per 100,000 population

T1DM

T2DM

Other types of diabetes

Total

T1DM

T2DM

Other types of diabetes

Total

Russian Federation 79 regions

2906

83542

796

87244

2.10

60.29

0.57

62.96

Adygea Republic

9

121

2

132

1.99

26.80

0.44

29.24

Altai Republic

4

79

0

83

1.86

36.72

0.00

38.58

Altai Territory

74

2837

63

2974

3.11

119.36

2.65

125.13

Amur Region

20

731

14

765

2.48

90.73

1.74

94.95

Arkhangelsk Region

38

1108

69

1215

3.36

98.03

6.10

107.50

Astrakhan Region

32

759

9

800

3.14

74.51

0.88

78.54

Bashkortostan Republic

134

3675

0

3809

3.29

90.27

0.00

93.56

Belgorod Region

40

1637

15

1692

2.58

105.60

0.97

109.15

Bryansk Region

69

1188

3

1260

5.63

96.92

0.24

102.79

Buryat Republic

2

180

0

182

0.20

18.32

0.00

18.53

Vladimir Region

32

783

2

817

2.29

56.04

0.14

58.48

Volgograd Region

67

2117

6

2190

2.63

83.15

0.24

86.02

Vologda Region

65

490

5

560

5.47

41.26

0.42

47.15

Voronezh Region

94

2403

119

2616

4.03

102.98

5.10

112.11

Dagestan Republic

2

28

0

30

0.07

0.93

0.00

0.99

Jewish Autonomous Oblast

0

3

0

3

0.00

1.81

0.00

1.81

Zabaykalsky Krai

25

431

2

458

2.31

39.80

0.18

42.29

Ivanovo Region

36

1095

26

1157

3.50

106.33

2.52

112.35

Ingush Republic

0

19

0

19

0.00

4.02

0.00

4.02

Irkutsk Region

0

0

0

0

0.00

0.00

0.00

0.00

Kabardino-Balkar Republic

0

9

0

9

0.00

1.04

0.00

1.04

Kaliningrad Region

12

202

0

214

1.23

20.69

0.00

21.92

Republic of Kalmykia

1

126

1

128

0.36

45.20

0.36

45.92

Kaluga Region

27

874

2

903

2.67

86.55

0.20

89.43

Kamchatka Krai

4

197

5

206

1.27

62.32

1.58

65.17

Karachai-Cherkess Republic

2

43

0

45

0.43

9.19

0.00

9.62

Republic of Karelia

23

389

1

413

3.65

61.76

0.16

65.57

Kemerovo Region

72

2151

11

2234

2.65

79.15

0.40

82.20

Kirov Region

23

1740

88

1851

1.77

134.11

6.78

142.66

Republic of Komi

35

916

46

997

4.08

106.91

5.37

116.36

Kostroma Region

21

401

1

423

3.22

61.55

0.15

64.93

Krasnodar Krai

146

4284

30

4460

2.65

77.70

0.54

80.89

Republic of Crimea

21

276

2

299

1.10

14.47

0.10

15.68

Kurgan Region

5

313

0

318

0.58

36.32

0.00

36.90

Kursk Region

55

887

4

946

4.91

79.20

0.36

84.46

Leningrad Region

29

195

0

224

1.63

10.96

0.00

12.59

Lipetsk Region

58

714

1

773

5.02

61.76

0.09

66.86

Magadan Region

0

24

0

24

0.00

16.40

0.00

16.40

Mari El Republic

24

664

1

689

3.50

96.81

0.15

100.46

Republic of Mordovia

42

765

0

807

5.20

94.74

0.00

99.94

Moscow

123

4959

5

5087

1.00

40.22

0.04

41.26

Moscow Region

160

5969

32

6161

2.19

81.56

0.44

84.18

Murmansk Region

6

312

2

320

0.79

40.94

0.26

41.99

Nenets Autonomous Area

0

0

0

0

0.00

0.00

0.00

0.00

Nizhny Novgorod Region

83

4058

82

4223

2.55

124.47

2.52

129.53

Novgorod Region

29

458

1

488

4.71

74.39

0.16

79.26

Novosibirsk Region

58

2323

40

2421

2.10

84.10

1.45

87.65

Omsk Region

19

593

5

617

0.96

29.97

0.25

31.19

Orenburg Region

66

2008

9

2083

3.31

100.66

0.45

104.42

Oryol Region

2

89

1

92

0.26

11.71

0.13

12.11

Penza Region

44

1595

7

1646

3.26

118.26

0.52

122.04

Perm Krai

75

2531

20

2626

2.85

96.07

0.76

99.68

Pskov Region

0

4

0

4

0.00

0.62

0.00

0.62

Rostov Region

82

3662

5

3749

1.94

86.45

0.12

88.50

Samara Region

89

1939

3

2031

2.78

60.48

0.09

63.35

Saint Petersburg

11

188

1

200

0.21

3.60

0.02

3.83

Saratov Region

0

0

0

0

0.00

0.00

0.00

0.00

Republic of Sakha/Yakutia

6

225

0

231

0.63

23.45

0.00

24.07

Sverdlovsk Region

114

2793

8

2915

2.63

64.50

0.18

67.32

Sevastopol

1

8

0

9

0.24

1.92

0.00

2.16

Republic of North Ossetia-Alania

0

2

0

2

0.00

0.28

0.00

0.28

Smolensk Region

23

324

0

347

2.40

33.80

0.00

36.20

Stavropol Territory

27

718

9

754

0.96

25.63

0.32

26.91

Tambov Region

10

366

7

383

0.95

34.85

0.67

36.47

Republic of Tatarstan

151

3122

4

3277

3.90

80.70

0.10

84.70

Tver Region

30

502

2

534

2.30

38.47

0.15

40.93

Tomsk Region

16

604

1

621

1.49

56.09

0.09

57.67

Tula Region

28

456

1

485

1.86

30.27

0.07

32.19

Republic of Tuva

0

0

0

0

0.00

0.00

0.00

0.00

Tyumen Region

30

1259

7

1296

2.06

86.55

0.48

89.10

Ulyanovsk Region

33

1130

1

1164

2.62

89.85

0.08

92.56

Khabarovsk Krai

11

362

0

373

0.82

27.13

0.00

27.95

Republic of Khakassia

10

515

3

528

1.86

95.94

0.56

98.36

Khanty-Mansijsk Autonomous District - Yugra

28

772

6

806

1.72

47.46

0.37

49.55

Chelyabinsk Region

99

2151

3

2253

2.83

61.44

0.09

64.36

Chechen Republic

5

185

0

190

0.36

13.27

0.00

13.63

Chuvash Republic

22

882

2

906

1.78

71.32

0.16

73.26

Yamalo-Nenets Autonomous District

9

136

1

146

1.69

25.46

0.19

27.34

Yaroslavl Region

63

1488

0

1551

4.95

116.99

0.00

121.94

Ivan Ivanovich Dedov

dedov@endocrincentr.ru
ORCID iD: 0000-0002-8175-7886
SPIN-code: 5873-2280
Endocrinology Research Centre
Russian Federation, 11 Dm.Ulyanova street, 117036 Moscow, Russia

MD, PhD, Professor

Marina Vladimirovna Shestakova

nephro@endocrincentr.ru
ORCID iD: 0000-0003-3893-9972
SPIN-code: 7584-7015
Endocrinology Research Centre; I.M.Sechenov First Moscow State Medical University
Russian Federation, 11 Dm.Ulyanova street, 117036 Moscow, Russia

MD, PhD, Professor

Olga Konstantinovna Vikulova

Author for correspondence.
olga-vikulova-1973@yandex.ru
ORCID iD: 0000-0003-0571-8882
SPIN-code: 9790-2665
Endocrinology Research Centre; I.M.Sechenov First Moscow State Medical University
Russian Federation, 11 Dm.Ulyanova street, 117036 Moscow, Russia

MD, PhD, associate professor

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  • Сахарный диабет типа 1: реалии и перспективы. / Под редакцией И.И. Дедова, М.В Шестаковой. – М.: «Медицинское информационное агентство»; 2016. [Saharnyj diabet tipa 1: realii i perspektivy. Ed by II Dedov, MV Shestakova. Moscow: «Medicinskoe informacionnoe agentstvo»; 2016. (in Russ)]
  • Сахарный диабет типа 2: от теории к практике. / Под редакцией И.И. Дедова, М.В Шестаковой. – М.: «Медицинское информационное агентство»; 2016. [Sakharnyy diabet tipa 2: ot teorii k praktike. Ed by II Dedov, MV Shestakova. Moscow: «Meditsinskoe informatsionnoe agentstvo»; 2016. (in Russ)]
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  • 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». / Под редакцией И.И. Дедова, Шестаковой М.В. – Москва; 2012. [Dedov II, Shestakova MV, Suntsov YuI, et al. Rezul'taty realizatsii podprogrammy «Sakharnyy diabet» Federal'noy tselevoy programmy «Preduprezhdenie i bor'ba s sotsial'no znachimymi zabolevaniyami 2007-2012 gody». Ed by II Dedov, MV Shestakova. Moscow; 2012. (in Russ)]
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  • 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. – Т. 18. – №3. – C. 5-22. [Dedov II, Shestakova MV, Vikulova OK. National register of diabetes mellitus in Russian Federation. Diabetes mellitus. 2015;18(3):5-22. (in Russ)] doi: 10.14341/DM201535-22.
  • Дедов И.И., Шестакова М.В., Галстян Г.Р. Распространенность сахарного диабета 2 типа у взрослого населения России (исследование NATION) // Сахарный диабет. – 2016. – Т. 19. – №2. – C. 104-112. [Dedov II, Shestakova MV, Galstyan GR. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes mellitus. 2016;19(2):104-112. (in Russ)] doi: 10.14341/DM2004116-17.
  • Дедов И.И., Шестакова М.В., Майоров А.Ю., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом / Под редакцией И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. – 8-й выпуск // Сахарный диабет. – 2017. – Т. 20. – №1S. – C. 1-121. [Dedov II, Shestakova MV, Mayorov AY, et al. Standards of specialized diabetes care. Edited by Dedov II, Shestakova MV, Mayorov AY. 8th edition. Diabetes mellitus. 2017;20(1S):1-121. (in Russ)] doi: 10.14341/DM20171S8.
  • 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.
  • Маслова О.В., Сунцов Ю.И., Шестакова М.В., и др. Распространенность диабетической нефропатии и хронической болезни почек при сахарном диабете в Российской Федерации. // Клиническая нефрология. – 2010. – №3. – С. 45-50. [Maslova OV, Suntsov YuI, Shestakova MV, et al. Prevalence of diabetic nephropathy and chronic kidney disease in diabetes mellitus in Russian Federation. Clinical nephrology. 2010.(3):45-50. (in Russ)]
  • Дедов И.И., Шестакова М.В., Андреева Е.Н., и др. Сахарный диабет: диагностика, диагностика, лечение, профилактика. / Под редакцией И.И. Дедова, М.В. Шестаковой. – Москва; 2011. [Dedov II, Shestakova MV, Andreeva EN, et al. Sakharnyy diabet: diagnostika, diagnostika, lechenie, profilaktika. Ed by Dedov II, Shestakova MV. Moscow; 2011. (in Russ)]
  • Дедов И.И., Шестакова М.В., Александров А.А., и др. Экономические аспекты сахарного диабета и его осложнений. Сахарный диабет: острые и хронические осложнения. / Под редакцией И.И. Дедова, М.В. Шестаковой. – Москва, 2011. [Dedov II, Shestakova MV, Aleksandrov AA, et al. Ekonomicheskie aspekty sakharnogo diabeta i ego oslozhneniy. / Sakharnyy diabet: ostrye i khronicheskie oslozhneniya. Ed by Dedov II, Shestakova MV. Moscow; 2011. (in Russ)]

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  • Buryukova EV, Jabbar A, Elizarova SV. When basal insulin is not enough: successful strategies for insulin intensification in patients with type 2 diabetes mellitus. Diabetes mellitus. 2017;20(5):363. doi: 10.14341/DM8824

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