thealthЗдравоохранение ТаджикистанаHealth care of Tajikistan0514-2415Редакция журнала «Здравоохранение Таджикистана»10.52888/0514-2515-2026-370-3-178-187thealth-781Research ArticleОБЗОРЫ ЛИТЕРАТУРЫREVIEW ARTICLESЭволюция управления рисками при сахарном диабете: от унифицированных запретов к персонализированным технологическим решениямEvolution of risk management in diabetes mellitus: from standardized restrictions to personalized technological solutionsКасымоваС. Д.QosimovaS. J.

Касымова Саломат Джамоловна – кандидат медицинских наук, заведующая кафедрой Эндокринологии

Душанбе

тел.: +992907744657

Qosimova Salomat Jamolovna – Candidate of Medical Sciences, Head of the Department of Endocrinology

Dushanbe

ksd19@mail.ruКафедра эндокринологии, ГОУ «Институт последипломного образования в сфере здравоохранения Республики Таджикистан»ТаджикистанDepartment of Endocrinology, SEI Institute of Postgraduate Education in Healthcare of the Republic of TajikistanTajikistan20260810202603178187Copyright © Касымова С.Д., 20262026Касымова С.Д.Qosimova S.J.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.zdrav.tj/jour/article/view/781

Сахарный диабет (СД) представляет собой одну из наиболее значимых медико-социальных проблем современности, характеризующуюся неуклонным ростом заболеваемости и высоким бременем осложнений. Исторически подход к управлению рисками базировался на жестких диетических ограничениях и унифицированных протоколах инсулинотерапии, что часто не обеспечивало достаточной компенсации и качества жизни пациентов. В условиях развития цифровых технологий и доказательной медицины парадигма лечения претерпевает фундаментальные изменения.

Анализ систематических обзоров литературы за период 2009-2024 гг., которые опубликованы в базах данных Pub Med, Scopus, Web of Sciens, eLibrary с результатами метаанализов, рандомизированных и когортных контролируемых исследований позволил выявить ключевые этапы перехода от унифицированных подходов к диагностике и лечению СД к персонализированным технологическим решениям в управлении диабетом. В статье установлено, что переход от концепции «избегания острых состояний» к стратегии «предотвращения хронических осложнений» стал возможен благодаря внедрению HbA1c (гликированного гемоглобина) как стандарта контроля эффективности назначенной терапии. Технологическая революция (создание аналогов инсулина, системы непрерывного мониторинга глюкозы, инсулиновые помпы) сместила фокус на вариабельность гликемии и время в целевом диапазоне в течение суток (TIR - time in range). Персонализация лечения теперь включает цифровые инструменты, фармакогенетику и психосоциальную поддержку пациентов СД.

Diabetes mellitus (DM) represents one of the most significant medico-social problems, characterized by a steady increase in morbidity and a high burden of complications. Historically, risk management was based on strict dietary restrictions and unified insulin therapy protocols, which often failed to ensure adequate compensation of the disease and a satisfactory quality of life for patients. In the context of the development of digital technologies and evidence-based medicine, the treatment paradigm is undergoing a fundamental change.

Systematic literature reviews published between 2009 and 2024 in PubMed, Scopus, Web of Science, and eLibrary, along with the results of meta-analyses, randomized controlled trials, and cohort studies, were analyzed to identify the key stages of the transition from unified approaches to the diagnosis and treatment of diabetes mellitus toward personalized technological solutions in diabetes management. This article established that the transition from the concept of “avoiding acute conditions” to the strategy of “preventing chronic complications” became possible due to the introduction of HbA1c (glycated hemoglobin) as a standard for monitoring the effectiveness of therapy. The technological revolution (development of insulin analogs, continuous glucose monitoring systems, insulin pumps) shifted the focus to glycemic variability and Time in Range (TIR) during the day. Treatment personalization now includes digital tools, pharmacogenetics, and psychosocial support.

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