medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-256medsovet-8508Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYСитаглиптин - ведущий препарат в лечении сахарного диабета 2-го типа, проверенный временемSitagliptin is a time-tested leading drug in the treatment of type 2 diabeteshttps://orcid.org/0000-0003-4929-1526КононенкоИ. В.KononenkoI. V.

Кононенко Ирина Владимировна - к.м.н., доцент кафедры диабетологии и диетологии Института высшего и дополнительного профессионального образования.

117036, Москва, ул. Дмитрия Ульянова, д. 11

Irina V. Kononenko - Cand. Sci. (Med.), Associate Professor of the Department of Diabetology and Dietetics of the Institute of Higher and Further Professional Education, Endocrinology Research Centre.

11, Dmitry Ulyanov St., Moscow, 117036

Kononenko.Irina@endocrincentr.ruhttps://orcid.org/0000-0003-3885-8988СмирноваО. М.SmirnovaO. M.

Смирнова Ольга Михайловна - д.м.н., профессор.

117036, Москва, ул. Дмитрия Ульянова, д. 11

Olga M. Smirnova - Dr. Sci. (Med.), Professor, Endocrinology Research Centre.

11, Dmitry Ulyanov St., Moscow, 117036

dr_smr@mail.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202402092024013138145Copyright © Кононенко И.В., Смирнова О.М., 20242024Кононенко И.В., Смирнова О.М.Kononenko I.V., Smirnova 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/8508

Ингибиторы дипептидилпептидазы 4-го типа занимают ведущее место в лечении сахарного диабета 2-го типа (СД) во всем мире благодаря патогенетически обоснованному механизму действия, низкому риску гипогликемических состояний и хорошей переносимости. На сегодняшний день это самый многочисленный класс сахароснижающих препаратов. Первый представитель данного класса - ситаглиптин является наиболее изученным и вместе с тем остается самым перспективным препаратом. Он может назначаться как на старте терапии, так и в дальнейшем в комбинации с другими классами сахароснижающих препаратов, в т. ч. с производными сульфонилмочевины. Глюкагоноподобный пептид-1 и глюкозозависимый инсулинотропный полипептид, концентрация которых в крови увеличивается под действием иДПП-4, усиливают стимулированную глюкозой секрецию инсулина путем активации сигнального пути циклического аденозинмонофосфата (цАМФ) в панкреатических β-клетках, при этом цАМФ играет критическую роль в повышении чувствительности β-клеток к глюкозе. Ситаглиптин имеет убедительную доказательную базу сердечно-сосудистой безопасности. Эффективность препарата сопоставима с эффективностью производных сульфонилмочевины. Вместе с тем низкий риск гипогликемических состояний и отсутствие побочных действий создают определенные преимущества применения данного препарата у пожилых пациентов. Активное применение препарата у пациентов с сахарным диабетом в Японии связано с преобладанием нарушения секреции в патогенезе заболевания и эффективностью иДПП в этой этнической группе. Плейотропные свойства препарата продолжают изучаться. Положительные эффекты ситаглиптина при коронавирусной инфекции могут быть связаны с противовоспалительными и иммуномодулирующими свойствами препарата. Рассматриваются возможности препарата в терапии иммуноопосредованных состояний, а также нейропротективные свойства в профилактике и лечении болезни Альцгеймера.

Dipeptidyl peptidase type 4 (DPP-4) inhibitors hold leadership positions in the treatment of type 2 diabetes worldwide due to their pathogenetically substantiated mechanism of action, low risk of hypoglycemic states and good tolerability. Today, they represent the largest class of glucose-lowering medicines. Sitagliptin, the first antidiabetic agent from this class, is the best known one and along with that remains the most promising medicine. It can be prescribed either as the initial treatment or later in a combination with other classes of hypoglycemic drugs, including sulfonylurea derivatives. Glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GIP), which blood concentrations increase under the effect of DPP-4 inhibitors, enhance glucose-stimulated insulin secretion through activating the cyclic adenosine monophosphate (cAMP) signaling pathway in pancreatic β-cells, meanwhile cAMP plays a critical role in an increase in β-cell sensitivity to glucose. Sitagliptin is an antidiabetic agent with significant data on cardiovascular safety. The efficacy of the drug is broadly similar to that of sulfonylurea derivatives. At the same time, the low risk of hypoglycemic states and the absence of side effects create certain advantages of using this drug in elderly patients. Active use of the drug in patients with diabetes in Japan is associated with the predominance of secretory disorders in the pathogenesis of the disease and the efficacy of DPP inhibitors in this ethnic group. The pleiotropic properties of the drug continue to be studied. The positive effects of sitagliptin in coronavirus infection may be associated with the anti-inflammatory and immunomodulatory properties of the drug. The potential of the drug in the treatment of immune-mediated conditions, as well as its neuroprotective properties in the prevention and treatment of Alzheimer's disease, are considered.

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