ALGORITHM FOR ASSESSING THE RISK OF MICROVASCULAR COMPLICATIONS IN PATIENTS WITH DM FOR A DOCTOR'S DECISION SUPPORT SYSTEM
Authors:   GBUZ Samara region ", Pervyshin Nikolay ,   The Samara city policlinic No. 4 of Kirovsky district",   Federal State Budgetary Educational Institution of Higher Education "The Samara state medical university" of the Ministry of Health of the Russian Federation, Lebedev Alexandr ,   Federal State Autonomous Educational Institution of Higher Education "N.I. Pirogov Russian National Research Medical University" of the Ministry of Health of the Russian Federation, Lebedeva Elena ,   Federal State Budgetary Educational Institution of Higher Education "The Samara state medical university" of the Ministry of Health of the Russian Federation, Galkin Rudolf ,   Federal State Budgetary Educational Institution of Higher Education "The Samara state medical university" of the Ministry of Health of the Russian Federation
Published: September 2023

Relevance: most experts agree that regular and high-quality dispensary monitoring of patients with diabetes mellitus at the outpatient stage is a necessary condition for preventing the development of vascular complications. The solution of this problem is closely connected with the development and widespread clinical implementation of digital healthcare tools, automated workplaces of doctors, decision support algorithms. Objective: to improve the quality and effectiveness of outpatient care for patients with type 2 diabetes mellitus by digitalizing outpatient admission, using the software of the automated workplace of an endocrinologist (AWPE DM), developing an algorithm for assessing the risk of microvascular complications as an element of a decision support system. Materials and methods: based on the analysis of the results of clinical experience in the use of ARME DM, an algorithm for assessing the risk of microvascular complications has been developed, which allows optimizing the complex of measures for dispensary observation of patients with type 2 diabetes mellitus. Results: demonstrated an increase in the efficiency and quality of medical care for patients with type 2 diabetes mellitus when using AWPE DM in clinical practice; developed a digital algorithm for assessing the risk of microvascular complications, providing stratification of the risks of their development according to the selected criteria for each of the classes; determination of a sufficient minimum of dispensary laboratory and instrumental studies, taking into account the level of credibility of recommendations; personalized correction of therapeutic goals of treatment taking into account the individual characteristics of the patient, including the stage of chronic kidney disease and diabetic retinopathy. Conclusions: the clinical application of the algorithm for assessing the risk of vascular complications, developed taking into account current domestic and foreign clinical recommendations, allows objectively in numerical values to assess the probability of progression of certain classes of microvascular complications of diabetes mellitus in a particular patient, to determine the activities of a personalized program of dispensary observation and rehabilitation. For laboratory and instrumental verification, examinations with the greatest diagnostic significance and suitable for storage and processing in digital format are proposed. Based on the results of the risk assessment directly during the outpatient appointment, the algorithm forms recommendations for the differentiated choice of therapeutic treatment goals, which makes it possible to optimize the personalized program of dispensary observation of the patient.