medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-211medsovet-7720Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYМесто метформина в современных клинических рекомендациях по лечению сахарного диабета 2-го типаPlace of metformin in modern clinical guidelines for the treatment of type 2 diabetes mellitushttps://orcid.org/0000-0003-1500-1586МоргуноваТ. Б.MorgunovaT. B.

Моргунова Татьяна Борисовна - кандидат медицинских наук, доцент кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского.

119991, Мос ква, ул. Трубецкая, д. 8, стр. 2

Tatyana B. Morgunova - Cand. Sci. (Med.), Associate Professor, Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

tanmorgun@mail.ruhttps://orcid.org/0000-0001-8505-5526ГлинкинаИ. В.GlinkinaI. V.

Глинкина Ирина Владимировна - кандидат медицинских наук, доцент кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Irina V. Glinkina - Cand. Sci. (Med.), Associate Professor, Еndocrinologist, Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

irina_glinkina@rambler.ruhttps://orcid.org/0000-0002-1809-7977ПешеваЕ. Д.PeshevaE. D.

Пешева Екатерина Дмитриевна - ассистент кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского, врач-эндокринолог.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Ekaterina D. Pesheva - Assistant of the Department of Endocrinology, Еndocrinologist, Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

ekaterinapesheva.endo@gmail.comhttps://orcid.org/0000-0002-2234-5283ЗоринаА. А.ZorinaA. A.

Зорина Анастасия Александровна - клинический ординатор кафедры эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Anastasia A. Zorina - Clinical Resident, Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

azorina97@yandex.ruhttps://orcid.org/0000-0002-3026-6315ФадеевВ. В.FadeevV. V.

Фадеев Валентин Викторович - чл.- корр. РАН, доктор медицинских наук, профессор, заведующий кафедрой эндокринологии №1 Института клинической медицины имени Н.В. Склифосовского.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Valentin V. Fadeev - Corr. Member RAS, Dr. Sci. (Med.), Professor, Chair of the Department of Endocrinology No. 1, Sklifosovsky Institute of Clinical Medicine.

8, Bldg. 2, Trubetskaya St., Moscow, 119991

walfad@mail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation202319082023013122129Copyright © Моргунова Т.Б., Глинкина И.В., Пешева Е.Д., Зорина А.А., Фадеев В.В., 20232023Моргунова Т.Б., Глинкина И.В., Пешева Е.Д., Зорина А.А., Фадеев В.В.Morgunova T.B., Glinkina I.V., Pesheva E.D., Zorina A.A., Fadeev V.V.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/7720

Сахарный диабет является одним из наиболее распространенных эндокринных заболеваний. Сахарный диабет 2-го типа ассоциирован с высокой сердечно-сосудистой заболеваемостью и смертностью и является ведущей причиной хронической болезни почек и терминальной стадии болезни почек. На сегодняшний день для лечения пациентов с сахарным диабетом 2-го типа используются сахароснижающие препараты, воздействующие на разные звенья патогенеза. Метформин – препарат из группы бигуанидов, широко применяющийся для лечения пациентов с сахарным диабетом 2-го типа как в монотерапии, так и в сочетании с другими сахароснижающими средствами. Помимо лечения сахарного диабета, метформин рекомендован и широко применяется для лечения преддиабета. Метформин характеризуется благоприятным профилем безопасности, он эффективен и доступен по цене; обеспечивает значимое улучшение гликемического контроля без увеличения риска гипогликемий. При применении метформина в монотерапии снижение уровня гликированного гемоглобина составляет в среднем 1–2%. Несмотря на появление в практике достаточно большого числа новых, эффективных сахароснижающих препаратов, метформин остается по-прежнему во многих случаях препаратом выбора. И большинством диабетических ассоциаций метформин рекомендуется в качестве препарата первой линии. Метформин продемонстрировал множество положительных эффектов в наблюдательных исследованиях у пациентов с ИБС, сердечной недостаточностью и хронической болезнью почек. В настоящем обзоре представлены данные об эффективности и плейотропных эффектах метформина. Также обсуждаются возможные нежелательные явления, в т. ч. риск развития недостаточности и дефицита витамина В12, нежелательные явления со стороны желудочно-кишечного тракта.

Diabetes mellitus is one of the most common endocrine diseases. Type 2 diabetes mellitus is associated with high cardiovascular morbidity and mortality and is a leading cause of chronic kidney disease and end-stage kidney disease. To date, for the treatment of patients with type 2 diabetes, hypoglycemic drugs are used that affect different parts of the pathogenesis. Metformin is a biguanide that is used in the treatment of type 2 diabetes mellitus; it is effective as monotherapy and in combination with other glucose-lowering medications. In addition to the treatment of diabetes mellitus, metformin is recommended and widely used for the treatment of prediabetes. Metformin is generally well-tolerated with minimal side effects and is affordable. Metformin is very effective in HbA1c lowering associated with some weight loss, but does not increase risk for hypoglycemia. With the use of metformin in monotherapy, the decrease in HbA1c levels is 1–2%. Despite the appearance in practice of a fairly large number of new, effective glucose-lowering drugs, metformin is still the drug of choice in many cases. And most diabetic associations recommend metformin as a first-line drug. Metformin has demonstrated many positive effects in observational studies in patients with CAD, heart failure, and chronic kidney disease. This review presents data on the efficacy and, pleiotropic effects of metformin. Possible adverse events are also discussed, including the risk of low level and deficiency of vitamin B12, gastrointestinal tract adverse events.

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