medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-12-246-255medsovet-6355Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYАналог инсулина длительного действия в терапии сахарного диабета 2-го типа: акцент на доказанную эффективность и безопасностьLong-acting insulin analogue in the treatment of type 2 diabetes mellitus: emphasis on proven efficacy and safetyБирюковаЕ. В.BiryukovaE. V.

д.м.н., профессор кафедры эндокринологии и  диабетологии, 

127473, Москва, ул. Делегатская, д. 20, стр. 1

Dr. Sci. (Med.), Professor of  the  Department of  Endocrinology and Diabetology, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473

lena@obsudim.ruШинкинМ. В.ShinkinM. V.

научный сотрудник отдела эндокринных и метаболических нарушений, врач эндокринолог отделения диагностики и общей терапии, 

111123, Москва, шоссе Энтузиастов, д. 86

Researcher, Department of Endocrine and Metabolic Disorders, Endocrinologist, Department of Diagnostics and General Therapy, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473

jendis@ya.ruМихееваО. М.MikheevaO. M.

д.м.н., профессор, заведующая отделением диагностики и общей терапии,

111123, Москва, шоссе Энтузиастов, д. 86

Dr. Sci. (Med.), Professor, Head of the Department of Diagnostics and General Therapy, 

20, Bldg. 1, Delegatskaya St., Moscow, 127473

ol.miheeva@mknc.ruМосковский государственный медикостоматологический университет имени А.И. ЕвдокимоваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian FederationМосковский клинический научный центр имени А.С. ЛогиноваРоссияYevdokimov Moscow State University of Medicine and DentistryRussian Federation202118092021012246255Copyright © Бирюкова Е.В., Шинкин М.В., Михеева О.М., 20212021Бирюкова Е.В., Шинкин М.В., Михеева О.М.Biryukova E.V., Shinkin M.V., Mikheeva O.M.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/6355

Со временем для достижения и поддержания целевых показателей гликемии назначение инсулинотерапии (ИТ) становится неизбежным для многих пациентов с сахарным диабетом (СД) 2-го типа. Согласно действующим рекомендациям добавление базального инсулина к сахароснижающей терапии при недостаточном контроле СД 2-го типа, постепенное титрование его дозы в соответствии с уровнем глюкозы крови натощак являются эффективным и безопасным методом инициирования ИТ. Рассматриваются свойства современных аналогов инсулина длительного действия. Гларгин 300 ЕД/мл – современный аналог инсулина длительного действия, предназначенный для введения один раз в сутки, основу которого составляет молекула гларгина. Увеличение концентрации гларгина в единице объема с формированием подкожного депо меньшей площади привело к изменению фармакокинетических свойств препарата. Гларгин 300 МЕ/мл по сравнению с гларгином 100 МЕ/мл обеспечивает более стабильное, продолжительное, предсказуемое действие с низкой вариабельностью гликемии, что снижает риск развития гипогликемии. Обсуждаются сахароснижающая эффективность и безопасность инсулина гларгина 300 ЕД/мл по данным программы международных клинических исследований III фазы EDITION. Инсулин гларгин 300 ЕД/мл показал сходное снижение уровней HbA1c по сравнению с инсулином гларгином 100 ЕД/мл с улучшенным профилем безопасности (более низким риском развития эпизодов подтвержденных или тяжелых гипогликемий в любое время суток, в т. ч. в ночное время) и менее выраженным влиянием на массу тела пациентов с СД 2-го типа. Эффективность и безопасность применения гларгина 300 ЕД/мл подтверждена у пациентов с СД 2-го типа с хронической болезнью почек и пожилого возраста. В исследовании BRIGHT гларгин 300 ЕД/мл продемонстрировал сопоставимый гликемический контроль в сравнении с инсулином деглудеком и более благоприятный профиль безопасности в течение первых 12 нед. Приведены результаты исследований TAKE CONTROL и ORION. 

In time, prescription of insulin therapy (IT) becomes inevitable for many patients with type 2 diabetes mellitus (DM) to achieve and maintain the target hypoglycemic range.

According to the current guidelines, the addition of basal insulin to glucose-lowering therapy in patients with insufficient control of type 2 diabetes, gradual titration of its dose in accordance with a fasting blood glucose level is an effective and safe method for initiating IT. The properties of modern long-acting insulin analogues are considered. Glargine 300 U/ml is a modern analogue of long-acting insulin that is intended to be used once a day. The glargine molecule forms the basis of the drug. Increasing the concentration of glargine per volume unit and formation of a smaller subcutaneous depot led to a change in the pharmacokinetic properties of the drug. Glargine 300 IU/ml provides a more stable, long-term, predictable action with low glycemic variability as compared with glargine 100 IU/ml, which reduces the risk of hypoglycemia. The sugar-reducing efficacy and safety of insulin glargine 300 U/ml as evidenced by the findings of the international clinical phase III EDITION studies are discussed. Insulin glargine 300 U/ml showed a similar decrease in HbA1c levels compared to insulin glargine 100 U/ml with an improved safety profile (lower risk of developing episodes of confirmed or severe hypoglycemia at all times of the day, including the nighttime) and a less pronounced effect on the body weight of patients with type 2 diabetes. The efficacy and safety of the use of glargine 300 U/ml has been confirmed in type 2 diabetes patients with chronic kidney disease and the elderly. In the BRIGHT study, glargine 300 U/ml showed comparable glycemic control when it is being compared. 

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