medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2020-7-50-55medsovet-5655Research ArticleСАХАРНЫЙ ДИАБЕТDIABETES MELLITUSАгонисты рецепторов глюкагоноподобного пептида-1, выбор внутри класса. Рациональная комбинация «инсулин гларгин 100 + ликсисенатид»Glucagon-like peptide-1 receptor agonists, selection within the class. The rational combination of insulin glargine 100 + lixisenatidehttps://orcid.org/0000-0002-1414-0034МартьяноваМ. В.MartjanovaM. V.

Мартьянова Мария Владимировна, аспирант кафедры эндокринологии, врач-эндокринолог высшей категории

197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2

Mariia V. Martjanova, Postgraduate student of the Department of Endocrinology, Board Certified in Endocrinology

2, Akkuratov St., St. Petersburg, 197341, Russia

ya.martjanova@yandex.ruhttps://orcid.org/0000-0002-0559-697XБабенкоА. Ю.BabenkoA. Yu.

Бабенко Алина Юрьевна, д.м.н., профессор кафедры внутренних болезней Института медицинского образования, главный научный сотрудник, руководитель научно-исследовательской лаборатории диабетологии Института эндокринологии, врач-эндокринолог высшей категории

197341, Россия, Санкт-Петербург, ул. Аккуратова, д. 2

Alina Yu. Babenko, Dr. of Sci. (Med)., Professor Department of Internal Medicine Institute of Medical Education, Leading Researcher, Head of Research Laboratory Institute of Diabetology

2, Akkuratov St., St. Petersburg, 197341, Russia

alina_babenko@mail.ruНациональный медицинский исследовательский центр им. В.А. АлмазоваРоссияAlmazov National Medical Research CentreRussian Federation202028052020075055Copyright © Мартьянова М.В., Бабенко А.Ю., 20202020Мартьянова М.В., Бабенко А.Ю.Martjanova M.V., Babenko A.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/5655

Сахарный диабет 2-го типа (СД2) – это прогрессирующее заболевание, сопровождающееся постепенным ухудшением функции β-клеток. При длительном течении СД2 у значительной части пациентов развивается абсолютная инсулинопения и возникает необходимость перевода пациента с пероральных сахароснижающих препаратов (ПСП) на терапию базальным инсулином в комбинации с ПСП или на базис-болюсную схему инсулинотерапии (ИТ). У более чем 80% пациентов с СД2 имеется ожирение или избыточная масса тела, и добавление к терапии инсулина, который является липогенетическим гормоном, способствует еще большей прибавке веса, что служит предпосылкой к повышению сердечно-сосудистых рисков, а также к появлению и прогрессированию биомеханических проблем, таких как артроз суставов, венозная недостаточность. В данной обзорной статье мы рассмотрим и оценим преимущества назначения пациентам, нуждающимся в интенсификации терапии, комбинации базального инсулина гларгин в сочетании с препаратом агонистов рецепторов глюкагоноподобного пептида-1 (арГПП-1) ликсисенатидом, как одну из наиболее рациональных схем лечения для пациентов с СД2 с дефицитом инсулина и сохраняющейся инсулинрезистентностью. Также в статье уделено внимание вариабельности гликемии, которая, по данным исследований, может играть важную роль в патогенезе атеросклероза и может быть независимым фактором риска сердечно- сосудистых осложнений у пациентов с диабетом. Ввиду того что гликемический контроль основан на определении преимущественно гликированного гемоглобина (HbA1c) в качестве меры средней концентрации глюкозы, известно, что этот маркер не точно отражает вариабельность гликемии, которая характеризуется амплитудой, частотой и продолжительностью гипо- и гипергликемических колебаний. Фиксированная комбинация препаратов инсулина гларгин 100 и арГПП-1 ликсисенатида позволит комплаентно подобрать индивидуально эффективную дозировку пациенту с СД2 и ожирением, поможет достичь нескольких целей одновременно – от улучшения гликемических показателей без увеличения массы тела и без повышения рисков гипогликемий до возможности существенно снизить потребность в инсулине при его предшествующем применении, а также снизить риск сердечно-сосудистых осложнений.

Type 2 diabetes mellitus (T2DM) is a progressive disease accompanied by a gradual worsening of β-cell function. With a long course of T2DM, a significant proportion of patients develop absolute insulinopenia and there is a need to transfer the patient from oral hypoglycemic drugs (OHD) to basal insulin therapy in combination with OHD or to the basal-bolus regimen of insulin therapy (IT). More than 80% of patients with T2DM are obese or overweight and the addition of insulin, which is a lipogenetic hormone, to the therapy contributes to even greater weight gain, which serves as a prerequisite for increasing cardiovascular risks, as well as the appearance and progression of biomechanical problems such as arthrosis of the joints, venous insufficiency. In this review article, we will consider and evaluate the benefits of administering combinations of basal insulin glargine in combination with glucagonlike peptide-1 receptor agonists (GLP-1ra) lixisenatide to one of the most rational treatment regimens for patients with T2DM insulin deficiency and persistent insulin resistance. Also, the article focuses on the variability of glycemia, which according to research can play an important role in the pathogenesis of atherosclerosis and can be an independent risk factor for cardiovascular complications in patients with diabetes. Due to the fact that glycemic control is based on the determination of predominantly glycated hemoglobin (HbA1c) as a measure of average glucose concentration, it is known that this marker does not accurately reflect glycemic variability, which is characterized by the amplitude, frequency and duration of hypo- and hyperglycemic fluctuations. A fixed combination of insulin preparations glargin 100 and GLP-1ra lixisenatide allows to select individually effective dosage for a patient with type 2 diabetes and obesity, will help to achieve several goals at the same time - from improving glycemic parameters without increasing body weight and without increasing the risk of hypoglycemia, to significantly reduce the need for insulin with its previous use, as well as reduce the risk of cardiovascular complications.

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