medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2022-16-10-22-32medsovet-6904Research ArticleСАХАРНЫЙ ДИАБЕТDIABETES MELLITUSОсобенности терапевтического обучения пожилых пациентов с сахарным диабетом 2-го типаSpecial considerations in the therapeutic education of elderly with diabetes mellitus type 2https://orcid.org/0000-0003-0809-0787БалашоваА. B.BalashovaA. V.

Балашова Анастасия Владимировна, врач-эндокринолог, аспирант, ассистент кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского

119435, Москва, ул. Погодинская, д. 1, стр. 1

 

Anastasia V. Balashova, Endocrinologist, Postgraduate Student, Assistant of the Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine

1, Bldg. 1, Pogodinskaya St., Moscow, 119435

nasta6koklina@mail.ruhttps://orcid.org/0000-0001-8505-5526ГлинкинаИ. В.GlinkinaI. V.

Глинкина Ирина Владимировна, кандидат медицинских наук, врач-эндокринолог, доцент кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского

119435, Москва, ул. Погодинская, д. 1, стр. 1

Irina V. Glinkina, Cand. Sci. (Med.), Endocrinologist, Associate Professor of the Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine

1, Bldg. 1, Pogodinskaya St., Moscow, 119435

irina_glinkina@rambler.ruhttps://orcid.org/0000-0001-6073-328XПавловаМ. Т.PavlovaM. G.

Павлова Мария Геннадиевна, кандидат медицинских наук, врач-эндокринолог, доцент кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского

119435, Москва, ул. Погодинская, д. 1, стр. 1

Maria G. Pavlova, Cand. Sci. (Med.), Endocrinologist,Associate Professor of the Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine

1, Bldg. 1, Pogodinskaya St., Moscow, 119435

fmgp.med@gmail.comhttps://orcid.org/0000-0002-1756-1950ОдерийА. В.OderiyA. V.

Одерий Анна Викторовна, врач-эндокринолог, кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского

119435, Москва, ул. Погодинская, д. 1, стр. 1

Anna V. Oderiy, Endocrinologist, Postgraduate Student, the Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine

1, Bldg. 1, Pogodinskaya St., Moscow, 119435

anya.oderij2112@gmail.comhttps://orcid.org/0000-0002-3026-6315ФадеевВ. В.FadeevV. V.

Фадеев Валентин Викторович, чл.-корр. РАН, доктор медицинских наук, врач-эндокринолог, заведующий кафедрой эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского

119435, Москва, ул. Погодинская, д. 1, стр. 1

Anna V. Oderiy, Endocrinologist, Postgraduate Student, the Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine

1, Bldg. 1, Pogodinskaya St., Moscow, 119435

walfad@mail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2022180620220102232Copyright © Балашова А.B., Глинкина И.В., Павлова М.Т., Одерий А.В., Фадеев В.В., 20222022Балашова А.B., Глинкина И.В., Павлова М.Т., Одерий А.В., Фадеев В.В.Balashova A.V., Glinkina I.V., Pavlova M.G., Oderiy A.V., Fadeev V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6904

Терапевтическое обучение – это важнейший элемент безопасного и успешного лечения многих хронических заболеваний, в т. ч. сахарного диабета (СД). Несмотря на то что данные по эффективности обучения в пожилом возрасте ограничены, обучение в том или ином объеме показано всем пациентам с СД вне зависимости от возраста. Формат и программа обучения определяются клинической ситуацией и особенностями пациента. Пожилые люди с СД 2-го типа представляют гетерогенную с клинической точки зрения группу: различаются не только по целям гликемического контроля, но и наличию возрастассоциированных проблем – так называемых гериатрических синдромов. Гериатрические синдромы могут как влиять на эффективность обучения, так и предопределять оптимальный формат обучения, что обусловливает необходимость их скрининга перед началом обучения. Для специалиста, проводящего обучение, наиболее значимыми среди этих синдромов представляются функциональная зависимость, когнитивные и сенсорные нарушения, депрессия, саркопения, мальнутриция и полипрагмазия. Улучшению обучения у пожилых пациентов с СД 2-го типа в реальной клинической практике могли бы способствовать: учет фенотипа пациента при выборе формата и программы обучения, создание гериатрических школ диабета с программой, направленной на решение более широкого спектра возраст-ассоциированных проблем, а также расширение баз для проведения школ. Также необходимо проведение клинических исследований, в которых эффективность обучения у пожилых людей с СД оценивалась бы не только с общепринятых диабетологических позиций, но и с учетом его влияния на возраст-ассоциированные проблемы.

Diabetes self-management education (DSME) is an essential part of effective and safe treatment of chronic conditions such as diabetes mellitus (DM). Though the data on DSME effectiveness in elderly are limited, all patients should be educated regardless of age. The form of learning and education program may vary depending on the clinical situation and the patient’s characteristics. Age-related problems, so-called geriatric syndromes, determinant heterogeneity of elderly diabetic population. Geriatric syndromes should be taken into account to choose proper treatment goals and optimal education programs. Functional dependency, cognitive decline, depression, sarcopenia, malnutrition and polypharmacy seems to be most important in the education context. The development of geriatric education program with a broad focus on solving both diabetic and age-related problems and its implementation on a wider range of institutions may be useful to improve diabetes self-management education of elderly in clinical practice. It is also necessary to initiate clinical studies to evaluate DSME effectiveness in elderly not only from the generally accepted diabetological criteria, but also considering its impact on age-related problems.

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