DIFFICULTIES IN MANAGING PATIENTS WITH TYPE 2 DIABETES, ACUTE CORONARY SYNDROME, AND MULTIFOCAL ATHEROSCLEROSIS IN REAL CLINICAL PRACTICE (BASED ON A CLINICAL CASE)

Highlights

• Diabetes mellitus is a severe, rapidly progressing disease. In the absence of high patient compliance, it is often associated with multifocal atherosclerosis, renal dysfunction, and acute cardiovascular events (myocardial infarction and stroke). Prevention of these complications and morbid conditions requires high patient commitment to the prescribed therapy, which is the main goal of managing a patient with diabetes mellitus.

Absract

The purpose is to present, by the example of a clinical case, relevant information for practicing physicians about the unfavorable, progressive, course of multifocal atherosclerosis in a patient with insufficient therapy of type 2 diabetes mellitus and having insufficient compliance with the prescribed drug therapy. The article describes a difficult case for doctors of an atypical course of acute coronary syndrome in such a patient and difficulties in choosing an effective method of myocardial revascularization. The presented clinical case illustrates the existing difficulties in managing patients with type 2 diabetes mellitus and atherosclerosis in real clinical practice. Attention is drawn to the need for early initiation of disease-modifying therapy and organ protection in type 2 diabetes mellitus, as well as to the need for screening for low adherence to prescribed treatment in such patients and its timely correction at all stages of treatment using digital technologies.

1. Bezdenezhnyh N.A., Sumin A.N., Bezdenezhnyh A.V., Ivanov S.V., Barbarash O.L., Barbarash L.S. Features of multifocal atherosclerosis in patients with type 2 diabetes mellitus and the impact of diabetes on the immediate outcomes of coronary artery bypass grafting. Russian Journal of Cardiology. 2015;(6):30-37. (In Russ.) https://doi.org/10.15829/1560-4071-2015-6-30-37

2. Dedov I.I., Shestakova M.V., Mayorov A.Y., Shamkhalova M.S., Sukhareva O.Yu., Galstyan G.R., Tokmakova A.Y., Nikonova T.V., Surkova E.V., Kononenko I.V., Egorova D.N., Ibragimova L.I., Shestakova E.A., Klefortova I.I., Sklyanik I.A., Yarek-Martynova I.Ya., Severina A.S., Martynov S.A., Vikulova O.K., Kalashnikov V.Y., Bondarenko I.Z., Gomova I.S., Starostina E.G., Ametov A.S., Antsiferov M.B., Bardymova T.P., Bondar I.A., Valeeva F.V., Demidova T.Y., Mkrtumyan A.M., Petunina N.A., Ruyatkina L.A., Suplotova L.A., Ushakova O.V., Khalimov Yu.Sh. Diabetes mellitus type 2 in adults. Diabetes mellitus. 2020;23(2S):4-102. (In Russ.) https://doi.org/10.14341/DM12507

3. Gracheva S.A., Klefortova I.I., Shamkhalova M.Sh. Prevalence of combined atherosclerotic vascular lesions in patients with diabetes mellitus. Diabetes mellitus. 2012;15(1):49-55. (In Russ.) https://doi.org/10.14341/2072-0351-5979

4. Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, Bernard R Chaitman, Jeroen J Bax, David A Morrow, Harvey D White, ESC Scientific Document Group; Fourth universal definition of myocardial infarction, 2018, European Heart Journal https://doi.org/10.1093/eurheartj/ehy462

5. Sedyh D. Ju., Alhimova T. S., Kashtalap V. V., Barbarash O. L. Active remote medical patronage of patients after myocardial infarction: are there any advantages over standard outpatient monitoring? Rational Pharmacotherapy in Cardiology. 2024;20(2):202 211. DOI: 10.20996/1819-6446-2024-3011. EDN XKNPWA

6. Barbarash L.S., Sumin A.N., Bezdenezhnykh A.V., Zhuchkova E.A., Barbarash O.L. Prevalence of polyvascular disease in patients with ishemic heart disease. Complex Issues of Cardiovascular Diseases. 2013;(3):4-11. (In Russ.) https://doi.org/10.17802/2306-1278-2013-3-4-11

7. Bezdenezhnykh N.A., Sumin A.N. Myocardial revascularization in patients with coronary heart disease and type 2 diabetes. Diabetes mellitus. 2016;19(6):471-478. (In Russ.) https://doi.org/10.14341/DM7922

8. Golikov A.P., Berns S.A., Strjuk R.I., Shmidt E.A., Golikova A.A., Barbarash O.L. Prognostic factors in patients with non-ST-segment elevation acute coronary syndrome and type 2 diabetes mellitus (according to registry results) Prognostic factors in patients with non-ST-segment elevation acute coronary syndrome and type 2 diabetes mellitus (according to registry results). Ter Arch. 2017;89(3):65–71. doi: 10.17116/terarkh201789365-71. PMID: 28378733.

9. Karetnikova V.N., Belenkova Ju.A., Zykov M.V., Kashtalap I.A., Shibanova I.A., Barbarash O.L. Multifocal atherosclerosis as a factor of unfavorable prognosis in patients with ST-segment elevation myocardial infarction and type 2 diabetes mellitus. Cardiology. 2013;53(4):12-8. PMID: 23952946.

10. Barbarash L.S., Sumin A.N., Bezdenezhnyh A.V., Zhuchkova E.A., Barbarash O.L. Prevalence of multifocal atherosclerosis in patients with ischemic heart disease. Complex issues of cardiovascular diseases. 2013;(3):4-11. https://doi.org/10.17802/2306-1278-2013-3-4-11

11. Barbarash, O.L., Sedyh D. Ju., Hryachkova O.N., Alhimova, T.S., Kashtalap V.V. Comparison of the efficacy of combination lipid-lowering therapy in patients with acute and chronic ischemic heart disease combined with severe dyslipidemia. RMJ. 2024; 15-19. 10.32364/2225-2282-2024-9-3.

12. Kashtalap V.V., Sedykh D.Yu. Effective antithrombotic therapy in multifocal atherosclerosis. Russian Medical Inquiry. 2024;8(1):42–47 (in Russ.). DOI: 10.32364/2587-6821-2024-8-1-7.

13.