medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-7-172-182medsovet-6152Research ArticleДИССЕРТАНТDISSERTANTВлияние андроген депривационной терапии на параметры углеводного обмена и амбулаторный гликемический профильInfluence of androgen deprivation therapy on glucose metabolism and ambulatory glucose profilehttps://orcid.org/0000-0002-0086-869XГрицкевичЕ. Ю.GrickevichE. Yu.

Грицкевич Елена Юрьевна - ассистент кафедры эндокринологии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1.

Elena Yu. Grickevich - Assistant of the Department of Endocrinology of the Medical Faculty, Pirogov Russian National Research Medical University.

1, Ostrovityanov St., Moscow, 117997.

genyan.7@mail.ruhttps://orcid.org/0000-0002-6899-4457СкуридинаД. В.SkuridinaD. V.

Скуридина Дарья Викторовна - ассистент кафедры эндокринологии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1.

Daria V. Skuridina - Assistant of the Department of Endocrinology of the Medical Faculty, Pirogov Russian National Research Medical University.

1, Ostrovityanov St., Moscow, 117997.

https://orcid.org/0000-0002-6276-2305ПереходовС. Н.PerekhodovS. N.

Переходов Сергей Николаевич – доктор медицинских наук, профессор, главный врач.

109263, Москва, ул. Шкулева, д. 4.

SRIN-код: 8770-6877

Sergey N. Perekhodov - Dr. Sci. (Med.), Professor, Chief Medical Officer, Demikhov City Clinical Hospital.

4, Shkulev St., Moscow, 109263.

s.perekhodov@bk.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationГородская клиническая больница имени В.П. ДемиховаРоссияDemikhov City Clinical HospitalRussian Federation20211205202107172182Copyright © Грицкевич Е.Ю., Скуридина Д.В., Переходов С.Н., 20212021Грицкевич Е.Ю., Скуридина Д.В., Переходов С.Н.Grickevich E.Y., Skuridina D.V., Perekhodov S.N.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6152Введение

Введение. Андроген-депривационная терапия, использующаяся для лечения рака предстательной железы, приводит к метаболическим нарушениям, в т. ч. нарушениям углеводного обмена. Сроки развития и особенности этих изменений изучены недостаточно. Расширение возможностей оценки гликемии позволяют детализировать информацию о характере и тенденциях этих изменений.

Цель исследования

Цель исследования. Изучение влияния длительной АДТ агонистами лютеинизирующего гормона рилизинг-гормона ЛГРГ (агонисты ЛГРГ) на параметры углеводного обмена и амбулаторный гликемический профиль у пациентов с местнораспространенным раком предстательной железы.

Материалы и методы

Материалы и методы. В исследование включено 99 пациентов с МР РПЖ, получающих АДТ агонистами ЛГРГ. Исследование уровней глюкозы плазмы натощак, гликированного гемоглобина выполнялись в динамике — исходно, через 3, 6 и 12 мес. АДТ. Был рекомендован постоянный самоконтроль гликемии с применением портативных глюкометров (Контур плюс, Асцензия). Десяти пациентам с выявленным повышением гликемии на фоне АДТ были установлены системы Flash-мониторинга глюкозы (FreeStyle Libre), позволяющие получить данные АГП.

Результаты и обсуждение

Результаты и обсуждение. Длительная АДТ у пациентов с МР РПЖ, независимо от исходного возраста, ИМТ, ОТ, сопровождалась ранним, прогрессирующим ухудшением всех показателей углеводного обмена с существенным увеличением доли пациентов с преддиабетическими значениями ГПН до 66% согласно критериям АDА. Выявлено, что 12-месячная АДТ изменяет АГП и сопровождается нарушением гликемии натощак, увеличением площади под кривой и уровней постпрандиальной гликемии, повышением вариабельности гликемии с увеличением индекса CONGA до 6,817 (p < 0,001).

Заключение

Заключение. АДТ агонистами ЛГРГ у пациентов с МР РПЖ сопровождается предрасположенностью к ранним нарушениям углеводного обмена с высоким риском быстрого развития преддиабета независимо от исходного возраста, ИМТ, ОТ, а АГП пациентов характеризуется возрастанием суммарной суточной гликемической нагрузки, вариабельности гликемии.

Introduction

Introduction. Androgen deprivation, used to treat prostate cancer, leads to metabolic disorders, including glucose metabolism disorders. The timing of development and the characteristics of these changes have not been sufficiently studied. The expansion of the possibilities for assessing glycemia makes it possible to obtain changes in glucose.

Objective

Objective. To study the dynamics of the effect of long-term androgen-deprivation therapy with gonadotropin-releasing hormone agonists (GnRH agonists) on the parameters of glucose metabolism and ambulatory glucose profile in patients with locally advanced prostate cancer (La PCa).

Materials and methods

Materials and methods. The study included 99 patients with La PCa receiving androgendeprivation therapy (ADT) with (GnRH agonists) for at least 12 months. The study of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) levels was performed at baseline, after 3, 6 and 12 months of ADT, and constant self-monitoring of glycemia was recommended using portable glucometers. Flash glucose monitoring systems (FreeStyle Libre) were installed in ten patients with a detected increase in glycemia on the background of ADT, allowing them to obtain data on the ambulatory glucose profile (AGP).

Results and discussion

Results and discussion. Long-term ADT in patients with La PCa, regardless of baseline age, BMI, WC, was accompanied by an early, progressive deterioration in parameters of glucose metabolism. The proportion of patients with prediabetic FPG values after 12 months becames 66% according ADA criteria. We found that 12-month ADT changes the AGP: an increase area under the curve and postprandial glycemic levels, an increase in blood glucose variability with an increase in the CONGA index to 6.817 (p < 0.001).

Conclusion

Conclusion. ADT by GnRH agonists in patients with La PCa is accompanied by a predisposition to early disorders of glucose metabolism with a high risk of rapid development of prediabetes regardless of baseline age, BMI, and WC. The AGP of patients is characterized by an increase in the total glycemic load, and glycemic variability.

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