Treatment of patients with diabetes mellitus: world practices are already in Ukraine

Diabetes mellitus is one of the most common metabolic disorders among the population not only in Ukraine, but throughout the world, and according to forecasts, unfortunately, the number of cases will only increase. The great danger of diabetes mellitus is that it is a complex disease that, in the absence of adequate treatment, quickly affects many organs (systemic atherosclerosis with the development of myocardial infarctions, strokes and impaired blood flow in the lower extremities, diabetic damage to the kidneys, eyes, nerve damage and the development of “diabetic foot”, often resulting in amputation). And, unfortunately, despite the modern possibilities of treating patients, the mortality rates among such patients are still quite high.

That is why in the developed countries of the world the newest medical direction is actively developing – cardiometabolic medicine. It is based on a fundamentally different approach – not treating a disease, but a person – based on a holistic view of the patient’s body and an integrated approach to its treatment.

For adequate treatment and follow-up of a patient with diabetes and the aforementioned “bunch” of complications, a whole team of specialists of various profiles and a wide arsenal of diagnostic and therapeutic options are needed. But even until recently in Ukraine, the approach to treating patients was extremely inefficient and inconvenient.

• specialists are usually needed “scattered” in different medical institutions;
• multidisciplinary hospitals lack all diagnostic capabilities;
• highly specialized institutions are engaged only in their own areas (cardiocenters operate on the heart, but they overlook everything else, vascular surgeons do not deal with diabetes, endocrinologists do not treat cardiovascular complications, etc.).

As a result, the patient goes from doctor to doctor and from medical institution to institution for weeks or months, wasting time, everyone treats him “little by little”, but due to the lack of communication between medical workers, each of the doctors has no idea about the complete picture of the patient.

But, fortunately, the situation in our country is changing, and, despite the state of war and the tragic events, the cardiometabolic approach has begun to be introduced in Ukraine (the country’s first department of cardiometabolic diseases has recently opened in the Kiev Center for Pediatric Cardiology and Cardiac Surgery, Clinic for Adults). Like the world cardiometabolic centers, with which the Ukrainian department cooperates, the best world practices are being introduced here and the same approach is professed: to treat a person, not a disease.

At the opening of a new department of cardiometabolic diseases, President of Ukraine Volodymyr Zelensky and head of the department of cardiometabolic diseases and the department of cardiovascular diabetology, Professor Boris Nikitovich Mankovsky.

How is the cardiometabolic approach implemented in Ukraine?

Firstly, the Department of Cardiometabolic Diseases brings together all the necessary specialists who work as a team on each patient – cardiologists, endocrinologists, nutritionists, neurologists, psychologists, and, if necessary, nephrologists, ophthalmologists, podols and physical therapists are also involved.

Secondly, the Center has all the diagnostic tools (CT, MRI, angiography, expert-level ultrasound diagnostic devices), as well as a modern medical laboratory that allows a wide range of laboratory studies (including all metabolic and hormonal panels).

That is, everything that the patient needs is collected in one place and at one time. Accordingly, all the necessary examinations and treatment procedures for patients with diabetes mellitus are carried out in one day (or rather, in 8 hours).

As a result, within 8 hours, the patient gradually goes through all the planned examinations, and as the results become available, each specialist forms his own opinion about the patient. By the end of the survey, all specialists come together and discuss, each of their positions, the patient’s condition and his therapy, reaching a consensus. Further, the patient’s “path” can develop according to two scenarios: if the patient does not need more serious additional examinations or interventions, he receives all the necessary recommendations and is discharged for observation. If complications are detected in a patient, he can undergo a full range of additional examinations: MRI of the heart, coronary angiography, CT angiography, the possibility of stenting atherosclerotic lesions, coronary artery bypass grafting, minimally invasive valve operations, etc.

In addition to working with patients with diabetes, the Department of Cardiometabolic Diseases pays great attention to the timely detection (at an early stage) of diseases provoked by diabetes. Since the team knows where diabetes hits most painfully, the list of studies clearly corresponds to the list of all common complications from carbohydrate metabolism disorders.

Such a holistic approach makes it possible to identify the disease at the stage of risk factors or in the early stages (which is not carried out in urban polyclinics under normal conditions), select the appropriate drug therapy and prevent diabetes and its satellite diseases from “starting up” and, accordingly, reaching the need for surgery. .