endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2024-5-3-10endofocus-99Research ArticleКЛИНИЧЕСКИЙ СЛУЧАЙCLINICAL CASEЦифровые помощники в реальной клинической практике на примере лечения пациента с сахарным диабетом 1 типаDigital assistants in real clinical practice on the example of treating a patient with type 1 diabeteshttps://orcid.org/0000-0001-7911-2424МарковаТ. Н.MarkovaT. N.

Маркова Татьяна Николаевна – д.м.н., профессор

г. Москва

Tatyana N. Markova – MD, PhD, Professor

Moscow

markovatn18@yandex.ruhttps://orcid.org/0000-0002-3375-1260СубботинаЛ. С.SubbotinaL. S.

Субботина Луиза Сергеевна – врач

г. Москва

Luiza S. Subbotina – MD

Moscow

luiza_subbotina@internet.ruhttps://orcid.org/0000-0002-9498-6039СтасМ. С.StasM. S.

Стас Мухамед Самих – аспирант

г. Москва

Mukhamed S. Stas – MD, PhD student

Moscow

hamudestas@gmail.comФГБОУ ВО «Российский университет медицины» Минздрава России; ГБУЗ «Городская клиническая больница № 52 ДЗМ»Rosunimed of MOH of Russia; Moscow City Clinical Hospital No. 52ГБУЗ «Городская клиническая больница № 52 ДЗМ»Moscow City Clinical Hospital No. 52202407112024537883Copyright © Маркова Т.Н., Субботина Л.С., Стас М.С., 20242024Маркова Т.Н., Субботина Л.С., Стас М.С.Markova T.N., Subbotina L.S., Stas M.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/99

Достижение компенсации показателей углеводного обмена является приоритетным направлением в лечении пациентов с сахарным диабетом (СД). Однако многократные измерения уровня глюкозы, в особенности у пациентов с СД 1 типа (СД1), приводят к быстрому выгоранию и повышению тревожности больного. Цифровые помощники способствуют повышению приверженности пациента к лечению, соблюдению графика ежедневных измерений показателей глюкозы крови, своевременной коррекции терапии и оптимизации разных видов медицинской помощи (традиционные визиты, телемедицинские консультации, онлайн-консультации). На основании данных клинических исследований на сегодняшний день известно, что использование цифровых помощников помогает в достижении стойкого клинического результата лечения, сокращении количества госпитализаций по поводу декомпенсации СД, снижении тревожности больного относительно своего заболевания. В статье представлен клинический случай ведения пациентки с СД1, использовавшей глюкометр с возможностью ведения электронного дневника самоконтроля, с последующим телемедицинским консультированием врача-эндокринолога на основании данных структурированных отчетов, формируемых в приложении медицинского прибора. Полученные результаты демонстрируют преимущества применения индивидуальных цифровых помощников в повседневной жизни пациентов с СД.

Achieving compensation of carbohydrate metabolism indicators is a priority in the treatment of patients with diabetes mellitus. However, repeated measurements of glucose levels, especially in patients with type 1 diabetes mellitus (T1D), lead to rapid burnout and increased anxiety of the patient. Digital assistants help to increase the patient's commitment to treatment, compliance with the schedule of daily measurements of blood glucose, timely correction of therapy and optimization of various types of medical care (traditional visits, telemedicine consultations, online consultations). Based on clinical research data, it is currently known that the use of digital assistants contributes to achieving a stable clinical result of treatment, reducing the number of hospitalizations for diabetes decompensation, and reducing patient anxiety about their disease. This article presents a clinical case of managing a patient with T1D who used a glucometer with the ability to maintain an electronic self-monitoring diary, followed by telemedicine consultation with an endocrinologist based on data from structured reports generated in the glucometer application. The results obtained demonstrate the advantages of using individual digital assistants in the daily life of patients with diabetes.

цифровые помощникителемедицинское консультированиесахарный диабетэлектронный дневникdigital assistantstelemedicine counselingdiabetes mellituselectronic diaryОбразцы продукции «Сателлит ONLINE» предоставлены производителем ООО «Компания «ЭЛТА»ReferencesBattelino T, Danne T, Bergenstal RM et al. Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the International Consensus on time in range. Diabetes Care. 2019; 42(8): 1593–603. doi: 10.2337/dci19-0028.Battelino T, Danne T, Bergenstal RM et al. Clinical targets for continuous glucose monitoring data interpretation: Recommendations from the International Consensus on time in range. Diabetes Care. 2019; 42(8): 1593–603. doi: 10.2337/dci19-0028.Danne T, Nimri R, Battelino T et al. International Consensus on use of continuous glucose monitoring. Diabetes care. 2017; 40(12): 1631–40. doi: 10.2337/dc17-1600.Danne T, Nimri R, Battelino T et al. International Consensus on use of continuous glucose monitoring. Diabetes care. 2017; 40(12): 1631–40. doi: 10.2337/dc17-1600.Powers MA, Bardsley JK, Cypress M et al. Diabetes self-management education and support in adults with type 2 diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care. 2020; 43(7): 1636–49. doi: 10.2337/dci20-0023.Powers MA, Bardsley JK, Cypress M et al. Diabetes self-management education and support in adults with type 2 diabetes: A Consensus Report of the American Diabetes Association, the Association of Diabetes Care & Education Specialists, the Academy of Nutrition and Dietetics, the American Academy of Family Physicians, the American Academy of PAs, the American Association of Nurse Practitioners, and the American Pharmacists Association. Diabetes Care. 2020; 43(7): 1636–49. doi: 10.2337/dci20-0023.Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care. 2002; 25(7): 1159–71. doi: 10.2337/diacare.25.7.1159.Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care. 2002; 25(7): 1159–71. doi: 10.2337/diacare.25.7.1159.Nkhoma DE, Soko CJ, Bowrin P et al. Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis. Comput Methods Programs Biomed. 2021; 210: 106370. doi: 10.1016/j.cmpb.2021.106370Nkhoma DE, Soko CJ, Bowrin P et al. Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis. Comput Methods Programs Biomed. 2021; 210: 106370. doi: 10.1016/j.cmpb.2021.106370Cooke D, Bond R, Lawton J et al. Structured type 1 diabetes education delivered within routine care: Impact on glycemic control and diabetes-specific quality of life. Diabetes Care. 2013; 36(2): 270–72. doi: 10.2337/dc12-0080.Cooke D, Bond R, Lawton J et al. Structured type 1 diabetes education delivered within routine care: Impact on glycemic control and diabetes-specific quality of life. Diabetes Care. 2013; 36(2): 270–72. doi: 10.2337/dc12-0080.Davidson P, LaManna J, Davis J et al. The effects of diabetes self-management education on quality of life for persons with type 1 diabetes: A systematic review of randomized controlled trials. Sci Diabetes Self Manag Care. 2022; 48(2): 111–35. doi: 10.1177/26350106211070266.Davidson P, LaManna J, Davis J et al. The effects of diabetes self-management education on quality of life for persons with type 1 diabetes: A systematic review of randomized controlled trials. Sci Diabetes Self Manag Care. 2022; 48(2): 111–35. doi: 10.1177/26350106211070266.He X, Li J, Wang B et al. Diabetes self-management education reduces risk of allcause mortality in type 2 diabetes patients: A systematic review and meta-analysis. Endocrine. 2017; 55(3): 712–31. doi: 10.1007/s12020-016-1168-2.He X, Li J, Wang B et al. Diabetes self-management education reduces risk of allcause mortality in type 2 diabetes patients: A systematic review and meta-analysis. Endocrine. 2017; 55(3): 712–31. doi: 10.1007/s12020-016-1168-2.Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. One-year outcomes of diabetes self-management training among Medicare beneficiaries newly diagnosed with diabetes. Med Care. 2017; 55(4): 391–97. doi: 10.1097/MLR.0000000000000653.Strawbridge LM, Lloyd JT, Meadow A, Riley GF, Howell BL. One-year outcomes of diabetes self-management training among Medicare beneficiaries newly diagnosed with diabetes. Med Care. 2017; 55(4): 391–97. doi: 10.1097/MLR.0000000000000653.Zhao X, Huang H, Zheng S. Effectiveness of internet and phone-based interventions on diabetes management of children and adolescents with type 1 diabetes: A systematic review. Worldviews Evid Based Nurs. 2021; 18(3): 217–25. doi: 10.1111/wvn.12511.Zhao X, Huang H, Zheng S. Effectiveness of internet and phone-based interventions on diabetes management of children and adolescents with type 1 diabetes: A systematic review. Worldviews Evid Based Nurs. 2021; 18(3): 217–25. doi: 10.1111/wvn.12511.Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017; 11(5): 1015–27. doi: 10.1177/1932296817713506.Greenwood DA, Gee PM, Fatkin KJ, Peeples M. A systematic review of reviews evaluating technology-enabled diabetes self-management education and support. J Diabetes Sci Technol. 2017; 11(5): 1015–27. doi: 10.1177/1932296817713506.Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the management of type 1 diabetes. Prev Chronic Dis. 2018; 15: E13. doi: 10.5888/pcd15.170168.Xu T, Pujara S, Sutton S, Rhee M. Telemedicine in the management of type 1 diabetes. Prev Chronic Dis. 2018; 15: E13. doi: 10.5888/pcd15.170168.Anderson A, O’Connell SS, Thomas C, Chimmanamada R. Telehealth interventions to improve diabetes management among Black and Hispanic patients: A systematic review and meta-analysis. J Racial Ethn Health Disparities. 2022; 9(6): 2375–86. doi: 10.1007/s40615-021-01174-6.Anderson A, O’Connell SS, Thomas C, Chimmanamada R. Telehealth interventions to improve diabetes management among Black and Hispanic patients: A systematic review and meta-analysis. J Racial Ethn Health Disparities. 2022; 9(6): 2375–86. doi: 10.1007/s40615-021-01174-6.Sherifali D, Brozic A, Agema P et al. Effect of diabetes health coaching on glycemic control and quality of life in adults living with type 2 diabetes: A community-based, randomized, controlled trial. Can J Diabetes. 2021; 45(7): 594–600. doi: 10.1016/j.jcjd.2020.11.012.Sherifali D, Brozic A, Agema P et al. Effect of diabetes health coaching on glycemic control and quality of life in adults living with type 2 diabetes: A community-based, randomized, controlled trial. Can J Diabetes. 2021; 45(7): 594–600. doi: 10.1016/j.jcjd.2020.11.012.Omar MA, Hasan S, Palaian S, Mahameed S. The impact of a self-management educational program coordinated through WhatsApp on diabetes control. Pharm Pract (Granada). 2020; 18(2): 1841. doi: 10.18549/PharmPract.2020.2.1841.Omar MA, Hasan S, Palaian S, Mahameed S. The impact of a self-management educational program coordinated through WhatsApp on diabetes control. Pharm Pract (Granada). 2020; 18(2): 1841. doi: 10.18549/PharmPract.2020.2.1841.Liang K, Xie Q, Nie J, Deng J. Study on the effect of education for insulin injection in diabetic patients with new simulation tools. Medicine (Baltimore). 2021; 100(14): e25424. doi: 10.1097/MD.0000000000025424.Liang K, Xie Q, Nie J, Deng J. Study on the effect of education for insulin injection in diabetic patients with new simulation tools. Medicine (Baltimore). 2021; 100(14): e25424. doi: 10.1097/MD.0000000000025424.Sahin C, Courtney KL, Naylor PJ, Rhodes RE. Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis. Digit Health .2019; 5: 2055207619845279. doi: 10.1177/2055207619845279.Sahin C, Courtney KL, Naylor PJ, Rhodes RE. Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis. Digit Health .2019; 5: 2055207619845279. doi: 10.1177/2055207619845279.Leong CM, Lee TI, Chien YM et al. Social media-delivered patient education to enhance self-management and attitudes of patients with type 2 diabetes during the COVID-19 pandemic: Randomized controlled trial. J Med Internet Res. 2022; 24(3): e31449. doi: 10.2196/31449.Leong CM, Lee TI, Chien YM et al. Social media-delivered patient education to enhance self-management and attitudes of patients with type 2 diabetes during the COVID-19 pandemic: Randomized controlled trial. J Med Internet Res. 2022; 24(3): e31449. doi: 10.2196/31449.Xia SF, Maitiniyazi G, Chen Y et al. Web-based TangPlan and WeChat combination to support self-management for patients with type 2 diabetes: Randomized controlled trial. JMIR Mhealth Uhealth. 2022; 10(3): e30571. doi: 10.2196/30571.Xia SF, Maitiniyazi G, Chen Y et al. Web-based TangPlan and WeChat combination to support self-management for patients with type 2 diabetes: Randomized controlled trial. JMIR Mhealth Uhealth. 2022; 10(3): e30571. doi: 10.2196/30571.Jiang Y, Ramachandran HJ, Teo JYC et al. Effectiveness of a nurse-led smartphone-based self-management programme for people with poorly controlled type 2 diabetes: A randomized controlled trial. J Adv Nurs. 2022; 78(4): 1154–65. doi: 10.1111/jan.15178.Jiang Y, Ramachandran HJ, Teo JYC et al. Effectiveness of a nurse-led smartphone-based self-management programme for people with poorly controlled type 2 diabetes: A randomized controlled trial. J Adv Nurs. 2022; 78(4): 1154–65. doi: 10.1111/jan.15178.Gershkowitz BD, Hillert CJ, Crotty BH. Digital coaching strategies to facilitate behavioral change in type 2 diabetes: A systematic review. J Clin Endocrinol Metab. 2021; 106(4): e1513–e1520. doi: 10.1210/clinem/dgaa850.Gershkowitz BD, Hillert CJ, Crotty BH. Digital coaching strategies to facilitate behavioral change in type 2 diabetes: A systematic review. J Clin Endocrinol Metab. 2021; 106(4): e1513–e1520. doi: 10.1210/clinem/dgaa850.Lee MK, Lee DY, Ahn HY, Park CY. A novel user utility score for diabetes management using tailored mobile coaching: Secondary analysis of a randomized controlled trial. JMIR Mhealth Uhealth. 2021; 9(2): e17573. doi: 10.2196/17573.Lee MK, Lee DY, Ahn HY, Park CY. A novel user utility score for diabetes management using tailored mobile coaching: Secondary analysis of a randomized controlled trial. JMIR Mhealth Uhealth. 2021; 9(2): e17573. doi: 10.2196/17573.Strategies to Enhance New CGM Use in Early Childhood (SENCE) Study Group. A randomized clinical trial assessing continuous glucose monitoring (CGM) use with standardized education with or without a family behavioral intervention compared with fingerstick blood glucose monitoring in very young children with type 1 diabetes. Diabetes Care. 2021; 44(2): 464–72. doi: 10.2337/dc20-1060.Strategies to Enhance New CGM Use in Early Childhood (SENCE) Study Group. A randomized clinical trial assessing continuous glucose monitoring (CGM) use with standardized education with or without a family behavioral intervention compared with fingerstick blood glucose monitoring in very young children with type 1 diabetes. Diabetes Care. 2021; 44(2): 464–72. doi: 10.2337/dc20-1060.Forjuoh SN, Reis MD, Couchman GR, Ory MG. Improving diabetes self-care with a PDA in ambulatory care. Telemed J E Health. 2008; 14(3): 273–79. doi: 10.1089/tmj.2007.0053.Forjuoh SN, Reis MD, Couchman GR, Ory MG. Improving diabetes self-care with a PDA in ambulatory care. Telemed J E Health. 2008; 14(3): 273–79. doi: 10.1089/tmj.2007.0053.Polisena J, Tran K, Cimon K et al. Home telehealth for diabetes management: A systematic review and meta-analysis. Diabetes Obes Metab. 2009; 11(10): 913–30. doi: 10.1111/j.1463-1326.2009.01057.x.Polisena J, Tran K, Cimon K et al. Home telehealth for diabetes management: A systematic review and meta-analysis. Diabetes Obes Metab. 2009; 11(10): 913–30. doi: 10.1111/j.1463-1326.2009.01057.x.Чичкова В.В., Шаповалова М.А., Чичкова М.А., Анциферов М.Б. Организация амбулаторной помощи пациентам с сахарным диабетом в условиях пандемии COVID-19 с применением телемедицинских технологий. Сахарный диабет. 2023; 26(4): 334–342. doi: 10.14341/DM13019.Чичкова В.В., Шаповалова М.А., Чичкова М.А., Анциферов М.Б. Организация амбулаторной помощи пациентам с сахарным диабетом в условиях пандемии COVID-19 с применением телемедицинских технологий. Сахарный диабет. 2023; 26(4): 334–342. doi: 10.14341/DM13019.Bujnowska-Fedak MM, Puchała E, Steciwko A. The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. Telemed J E Health. 2011; 17(3): 153–63. doi: 10.1089/tmj.2010.0113.Bujnowska-Fedak MM, Puchała E, Steciwko A. The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland. Telemed J E Health. 2011; 17(3): 153–63. doi: 10.1089/tmj.2010.0113.Ballesta S, Chillarón JJ, Inglada Y et al. Telehealth model versus in-person standard care for persons with type 1 diabetes treated with multiple daily injections: An open-label randomized controlled trial. Front Endocrinol (Lausanne). 2023 Jun; 14: 1176765. doi: 10.3389/fendo.2023.1176765.Ballesta S, Chillarón JJ, Inglada Y et al. Telehealth model versus in-person standard care for persons with type 1 diabetes treated with multiple daily injections: An open-label randomized controlled trial. Front Endocrinol (Lausanne). 2023 Jun; 14: 1176765. doi: 10.3389/fendo.2023.1176765.

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