Введение

medsovet

Медицинский Совет

Meditsinskiy sovet = Medical Council

2079-701X2658-5790

REMEDIUM GROUP Ltd.

10.21518/ms2024-394

medsovet-8621

Research Article

САХАРНЫЙ ДИАБЕТ

DIABETES MELLITUS

Вектор гликированного гемоглобина в формировании дисгликемии в постменопаузе: акценты ранней диагностики и терапии

Vector of glycated hemoglobin in the formation of dysglycemia in postmenopause: Emphasis on early diagnosis and therapy

https://orcid.org/0000-0002-6762-5238

Руяткина

Л. А.

Ruyatkina

L. A.

Руяткина Людмила Александровна, д.м.н., профессор

630091, Новосибирск, Красный проспект, д. 52

Lyudmila A. Ruyatkina, Dr. Sci. (Med.), Professor

52, Krasny Ave., Novosibirsk, 630091

larut@list.ru

https://orcid.org/0000-0003-3431-5943

Руяткин

Д. С.

Ruyatkin

D. S.

Руяткин Дмитрий Сергеевич, к.м.н., доцент

630091, Новосибирск, Красный проспект, д. 52

Dmitriy S. Ruyatkin, Cand. Sci. (Med.), Associate Professor

52, Krasny Ave., Novosibirsk, 630091

dr79@mail.ru

https://orcid.org/0000-0001-9270-9188

Щербакова

Л. В.

Shcherbakova

L. V.

Щербакова Лилия Валерьевна, cтарший научный сотрудник

630089, Новосибирск, ул. Б. Богаткова, д. 175/1

Lilia V. Shcherbakova, Senior Researcher

175/1, B. Bogatkov St., Novosibirsk, 630089

9584792@mail.ru

https://orcid.org/0000-0002-1981-7294

Исхакова

И. С.

Iskhakova

I. S.

Исхакова Ирина Сергеевна, к.м.н., врач-эндокринолог

630005, Новосибирск, ул. Гоголя, д. 42

Irina S. Iskhakova, Cand. Sci. (Med.), Endocrinologist

42, Gogol St., Novosibirsk, 630001

tyutyunjon@mail.ru

Новосибирский государственный медицинский университетРоссияNovosibirsk State Medical UniversityRussian Federation

Научно-исследовательский институт терапии и профилактической медициныРоссияResearch Institute of Internal and Preventive MedicineRussian Federation

ООО «Андромед-Клиника»РоссияLLC Andromed-ClinicRussian Federation

2024

31102024

016135147

2024

Руяткина Л.А., Руяткин Д.С., Щербакова Л.В., Исхакова И.С.

Ruyatkina L.A., Ruyatkin D.S., Shcherbakova L.V., Iskhakova I.S.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.med-sovet.pro/jour/article/view/8621

Введение

Введение. Тесная связь постменопаузы с инсулинорезистентностью (ИР) и метаболическим синдромом (МетС) маркирует высокий кардиометаболический риск дисгликемии, определяя необходимость ее ранней диагностики и терапии. Патогенетически обоснованные критерии диагностики предиабета и характер ранней медикаментозной терапии сахарного диабета 2-го типа (СД2) дискутируются. Сведения о взаимосвязях параметров глюкозного гомеостаза и менопаузального МетС фрагментарны.

Цель

Цель. Оценить ассоциации гликированного гемоглобина (HbA1c) с индексами ИР, функцией β-клеток и характеристиками МетС в когорте постменопаузальных женщин с различным состоянием углеводного обмена.

Материалы и методы

Материалы и методы. У 94 европеоидных женщин в постменопаузе 58,0 (53,0; 63,0) лет определены: HbA1c, гликемия натощак (ГН), индексы TyG и линейки HOMA2, С-пептид, ИМТ, окружность талии (ОТ), уровни артериального давления (АД), триглицеридов (ТГ), ХС-ЛПВП. При классификации женщин по HbA1c (критерии ADA) 15 имели нормогликемию, 24 – предиабет, 55 – СД2. С помощью SPSS (версия 17) оценивали ME (25–75%); межгрупповые различия по критерию Mанна – Уитни; проводили корреляционный анализ по Спирмену и partial correlation.

Результаты

Результаты. HbA1c-возраст независимо коррелировал с параметрами ИР: TyG (R = 0,590; p < 0,001), HOMA2-IR (R = 0,318; p < 0,05) и функцией ꞵ-клеток: HOMA2-B (R = -0,355; p < 0,001); с липидными маркерами МетС (ТГ, ХС-ЛПВП, R = 0,382;

-0,448; p < 0,001 соответственно), антропометрическими и уровнями АД.

Выводы

Выводы. Ассоциация HbA1c у постменопаузальных женщин со спектром параметров глюкозного гомеостаза и МетС маркируют его как вектор формирования и прогрессирования дисгликемии вследствие тесной связи с функциональным состоянием β-клеток и значением липоглюкотоксичности в динамике постменопаузальной ИР. Полученные данные патогенетически определяют использование HbA1c в верификации дисгликемии и раннее назначение комбинированной антигипергликемической терапии, направленной на сохранение функции β-клетки. Рассматривается потенциал ингибиторов дипептидилпептидазы-4 в замедлении прогрессирования сахарного диабета 2-го типа.

Introduction

Introduction. The close relationship of postmenopause with insulin resistance (IR) and metabolic syndrome (MetS) marks a high cardiometabolic risk of dysglycemia, determining the need for its early diagnosis and therapy. Pathogenetically substantiated criteria for the diagnosis of prediabetes and the nature of early drug therapy for type 2 diabetes mellitus (T2DM) are debated. Information on the relationship between glucose homeostasis parameters and menopausal MetS is fragmentary.

Aim

Aim. To evaluate the associations of glycated hemoglobin (HbA1c) levels with indices of IR, β-cell function and MetS character- istics in a cohort of postmenopausal women with different carbohydrate metabolic states.

Materials and methods

Materials and methods. In 94 Caucasian postmenopausal women 58.0 (53.0; 63.0) years old the following were determined: HbA1c, fasting glycemia (FG), TyG and HOMA2 indices, C-peptid, BMI, waist circumference (WC), blood pressure (BP), triglycerides (TG), HDL-C levels. When classifying women by HbA1c (ADA criteria), 15 had normoglycemia, 24 prediabetes, 55 T2DM. ME (25–75%) was assessed using SPSS (version 17); intergroup differences according to the Mann – Whitney test; Spearman and partial correlation analysis were performed.

Results

Results. HbA1c age independently correlated with IR parameters: TyG (R = 0.590; p < 0.001), HOMA2-IR (R = 0.318; p < 0.05) and beta cell function: HOMA2-B (R = -0.355; p < 0.001); with lipid markers of MetS (TG, HDL-C, respectively R = 0.382; -0.448; p < 0.001), anthropometric and blood pressure levels.

Conclusion

Conclusion. Associations of HbA1c in postmenopausal women with a spectrum of glucose homeostasis parameters and MetS mark it as a vector of formation and progression of dysglycemia due to a close connection with the functional state of β-cells and the importance of lipoglucotoxicity in the dynamics of postmenopausal IR. The obtained data pathogenetically determine the use of HbA1c in the verification of dysglycemia and the early administration of combined antihyperglycemic therapy aimed at preserving β-cell function. The potential of dipeptidyl peptidase-4 inhibitors in slowing the progression of type 2 diabetes mellitus is considered

метаболический синдроминсулинорезистентностьиндекс TyGиндексы HOMA2инсулинчувствительностьингибиторы дипептидипептидазы-4алоглиптин

metabolic syndromeinsulin resistanceTyG indexHOMA2 indicesinsulin sensitivitydipeptidyl peptidase-4 inhibitorsalogliptin

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