Follow up of clinical outcomes in type 1 diabetic patients according to the results of dynamic examination in the mobile center "Diamobil"

Background. Type 1 diabetes mellitus (T1DM) is a severe disease associated with reduced life expectancy. Understanding the causes and methods of reducing risks for this cohort is highly relevant for developing measures to reduce the number of years lost.

Aim. To assess clinical outcomes: the frequency of diabetic complications, structure of mortality among T1DM patients who were examined at dynamic examination in the mobile center "Diamobil" in the Arkhangelsk region in 2005 and 2023.

Materials and methods. The study was conducted on a cohort of patients with T1DM, examined at "Diamobil" in Arkhangelsk region in 2005 (n=319), with dynamic follow up of vital and clinical status, clinical parameters and frequency of complications over an 18-year period. At 2023, out of 319 people in the primary cohort – 61 patients died, 206 were in "alive" status and 52 were removed from analysis. Statistical analysis is performed with the help of Statistics v.13.3.

Results. In the dynamic cohort (n=206) at 2023 median age of patients was 40 years [34; 55], duration of DM – 28 years [24; 33], percentage of women – 55%. Compared to 2005, glycated hemoglobin was comparable, there were an increase in body mass index (21.9 kg/m² vs 25.1 kg/m²) and obesity rate from 3.1 to 11.2% (p=0.006), a decrease in estimated glomerular filtration rate (103.1 ml/min/1.73 mm² vs 86.4 ml/min/1.73 mm²; p<0.001) and increased frequency of diabetic complications: chronic kidney disease (CKD) any stage from 24.9 to 69.4%, Stage 3a CKD from 0.5 to 7.4% (p=0.003), diabetic retinopathy from 26.4 to 74.6%, diabetic neuropathy from 25.9 to 78.2% (p<0.001), which reflects the long-term effect of the hyperglycemia factor. Based on the results of the analysis of mortality structure by proximal cause, it was established that the most frequent causes of death were cardiovascular disease – myocardial infarction, acute cerebral circulation disorder, heart failure and other cardiovascular diseases – 42.6%; death due to hypoglycemic and ketoacidotic coma – 3.2%, terminal cardiovascular disease – 14.8%. Deceased patients were characterized by a longer duration of DM (13 years vs 8 years), higher glycated hemoglobin (9.4% vs 8.4%), lipid profile (total cholesterol 4.77 mmol/l vs 4.41 mmol/l; TG 1.31 mmol/l vs 0.98 mmol/l) and albuminuria (70 mg/mmol vs 6 mg/mmol; p<0.001).

Conclusion. "Diamobil" control epidemiological studies can be positioned as the optimal method of risk cohort survey coverage for the assessment of dynamic indicators in real clinical practice.