medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-156medsovet-9054Research ArticleЭНДОКРИНОЛОГИЯENDOCRINOLOGYЭффективность метформина у пациентки с предиабетом в рамках прегравидарной подготовкиEfficacy of metformin in a patient with prediabetes in the framework of pregravity preparationhttps://orcid.org/0000-0001-7874-2176БатракГ. А.BatrakG. A.

Батрак Галина Алексеевна, д.м.н., доцент, профессор кафедры терапии, эндокринологии и диетологии

153012, Иваново, Шереметевский проспект, д. 8

Galina A. Batrak, Dr. Sci. (Med.), Associate Professor, Professor of the Department of Therapy, Endocrinology and Dietetics

8, Sheremetevsky Ave., Ivanovo, 153012

gbatrak@mail.ruhttps://orcid.org/0000-0003-4028-0708ЖабуринаМ. В.ZhaburinaM. V.

Жабурина Мария Владимировна, к.м.н., доцент кафедры оториноларингологии и офтальмологии

153012, Иваново, Шереметевский проспект, д. 8

Maria V. Zhaburina, Cand. Sci. (Med.), Associate Professor of the Department of Otorhinolaryngology and Ophthalmology

8, Sheremetevsky Ave., Ivanovo, 153012

https://orcid.org/0000-0002-5230-9961БатракН. В.BatrakN. V.

Батрак Наталия Владимировна, к.м.н., доцент кафедры акушерства, гинекологии и медицинской генетики

153012, Иваново, Шереметевский проспект, д. 8

Natalia V. Batrak, Cand. Sci. (Med.), Associate Professor of the Department of Obstetrics, Gynecology and Medical Genetics

8, Sheremetevsky Ave., Ivanovo, 153012

Ивановский государственный медицинский университетРоссияIvanovo State Medical UniversityRussian Federation20250405202505102106Copyright © Батрак Г.А., Жабурина М.В., Батрак Н.В., 20252025Батрак Г.А., Жабурина М.В., Батрак Н.В.Batrak G.A., Zhaburina M.V., Batrak N.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/9054

Предиабет нередко выявляется у женщин молодого возраста, планирующих беременность. Проведена оценка эффективности метформина в нормализации метаболических и гормональных показателей у женщины с предиабетом. Пациентка Н. 33 лет с ожирением и повышением артериального давления (АД) планирует беременность. Ожирение 6 лет, в течение года прибавка веса 7 кг, нарушение менструального цикла, АД до 150/90 мм рт. ст. Окружность талии (ОТ) 98 см, окружность бедер (ОБ) 86, ОТ/ОБ 1,1, рост 166 см, вес 84 кг, индекс массы тела (ИМТ) 30,5 кг/м², АД 140/85 мм рт. ст., глюкоза венозной плазмы 6,2 ммоль/л. У пациентки гиперинсулинемия, инсулинорезистентность и дислипидемия. На фоне гипокалорийной диеты и расширения физической активности назначен метформин 1000 мг с оценкой метаболических и гормональных нарушений через 6 и 12 мес. Через 12 мес. вес 69 кг (-15 кг), ОТ 77 см (-13 см), ИМТ 25 кг/м² (-5,5 кг/м2,), HOMA-IR 0,87 (-4,83), АД 110/70 мм рт. ст., ТГ 0,9 ммоль/л (-1,0), ХС ЛПНП 1,7 ммоль/л (-1,6), ХС ЛПВП 1,3 ммоль/л (+0,4), глюкоза венозной плазмы 4,0 ммоль/л, инсулин 4,9 мкЕд/мл. Нормализация гормонов: ЛГ 5,7, ФСГ 3,8 МЕ/л, ЛГ/ФСГ 1,5, тестостерон 1,2 нмоль/л. Регулярный менструальный цикл через 6 мес. Метформин 1000 мг/сут у пациентки молодого возраста с предиабетом на фоне гипокалорийной диеты и расширения физических нагрузок эффективно снизил массу тела, нормализовал индекс инсулинорезистентности, метаболические и гормональные показатели, необходимые для планирования беременности.

Prediabetes is often detected in young women planning pregnancy. The effectiveness of metformin in normalizing metabolic and hormonal parameters in a woman with prediabetes was assessed. Patient H., 33 years old, with obesity and high blood pressure (BP), is planning pregnancy. Obesity for 6 years, weight gain of 7 kg during the year, menstrual cycle irregularities, BP up to 150/90 mm Hg. Waist circumference (WC) 98 cm, hip circumference (HC) 86, WC/HC 1.1, height 166 cm, weight 84 kg, body mass index (BMI) 30.5 kg/m², BP 140/85 mm Hg, venous plasma glucose 6.2 mmol/l. The patient has hyperinsulinemia, insulin resistance and dyslipidemia. Against the background of a hypocaloric diet and increased physical activity, metformin 1000 mg was prescribed with an assessment of metabolic and hormonal disorders after 6 and 12 months. After 12 months, weight was 69 kg (-15 kg), WC 77 cm (-13 cm), BMI 25 kg/m² (-5.5 kg/m2), HOMA-IR 0.87 (-4.83), BP 110/70 mmHg, TG 0.9 mmol/l (-1.0), LDL-C 1.7 mmol/l (-1.6), HDL-C 1.3 mmol/l (+0.4), venous plasma glucose 4.0 mmol/l, insulin 4.9 μU/ml. Normalization of hormones: LH 5.7, FSH 3.8 IU/l, LH/FSH 1.5, testosterone 1.2 nmol/l. Regular menstrual cycle after 6 months. Metformin 1000 mg per day in a young patient with prediabetes against the background of a hypocaloric diet and increased physical activity effectively reduced body weight, normalized the insulin resistance index, metabolic and hormonal parameters necessary for pregnancy planning.

предиабетабдоминальное ожирениеинсулинорезистентностьиндекс HOMA-IRметформинprediabetesabdominal obesityinsulin resistanceHOMA-IR indexmetforminReferencesДедов ИИ, Шестакова МВ, Майоров АЮ (ред.). Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 11-й выпуск. М.; 2023. 236 с. Режим доступа: https://www.endocrincentr.ru/sites/default/files/specialists/science/clinic-recomendations/2023_alg_sum.pdf.Дедов ИИ, Шестакова МВ, Майоров АЮ (ред.). Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 11-й выпуск. М.; 2023. 236 с. Режим доступа: https://www.endocrincentr.ru/sites/default/files/specialists/science/clinic-recomendations/2023_alg_sum.pdf.Дедов ИИ, Шестакова МВ, Галстян ГР. Распространенность сахарного диабета 2 типа у взрослого населения России (исследование NATION). Сахарный диабет. 2016;19(2):104–112. https://doi.org/10.14341/DM2004116-17.Dedov II, Shestakova MV, Galstyan GR. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Mellitus. 2016;19(2):104–112. (In Russ.) https://doi.org/10.14341/DM2004116-17.Garber AJ, Handelsman Y, Einhorn D, Bergman DA, Bloomgarden ZT, Fonseca V et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Endocr Pract. 2008;14(7):933–946. https://doi.org/10.4158/EP.14.7.933.Garber AJ, Handelsman Y, Einhorn D, Bergman DA, Bloomgarden ZT, Fonseca V et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Endocr Pract. 2008;14(7):933–946. https://doi.org/10.4158/EP.14.7.933.Шестакова МВ, Викулова ОК, Железнякова АВ, Дедов ИИ, Мокрышева НГ. Сахарный диабет 2-го типа: клинические рекомендации против реальной клинической практики. Терапевтический архив. 2023;95(10):833–838. https://doi.org/10.26442/00403660.2023.10.202424.Shestakova MV, Vikulova OK, Zheleznyakova AV, Dedov II, Mokrysheva NG. Diabetes mellitus type 2: National Russian guidelines vs real clinical practice. Terapevticheskii Arkhiv. 2023;95(10):833–838. (In Russ.) https://doi.org/10.26442/00403660.2023.10.202424.Драпкина ОМ, Дроздова ЛЮ, Шепель РН, Раковская ЮС, Самойлов ТВ, Жидкова ЕА и др. Анализ распространенности предиабета и реальная клиническая практика назначения медикаментозной терапии пациентам с предиабетом. Профилактическая медицина. 2022;25(12):96–105. https://doi.org/10.17116/profmed20222512196.Drapkina OM, Drozdova LYu, Shepel RN, Rakovskaya YuS, Samoylov TV, Zhidkova EA et al. Analysis of prediabetes prevalence and real-world practice in prescribing drug therapy to prediabetic patients. Profilakticheskaya Meditsina. 2022;25(12):96-105. (In Russ.) https://doi.org/10.17116/profmed20222512196.Овсянникова АК, Зубарева ДЮ. Особенности течения сахарного диабета 2-го типа у лиц молодого возраста. Медицинский совет. 2022;(10):57–61. https://doi.org/10.21518/2079-701X2022-16-10-57-61.Ovsyannikova AK, Zubareva DYu. Features of the course of type 2 diabetes mellitus in young people. Meditsinskiy Sovet. 2022;(10):57–61. (In Russ.) https://doi.org/10.21518/2079-701X2022-16-10-57-61.Magliano DJ, Sacre JW, Harding JL, Gregg EW, Zimmet PZ, Shaw JE. Youngonset type 2 diabetes mellitus – implications for morbidity and mortality. Nat Rev Endocrinol. 2020;16(6):321–331. https://doi.org/10.1038/s41574-020-0334-z.Magliano DJ, Sacre JW, Harding JL, Gregg EW, Zimmet PZ, Shaw JE. Youngonset type 2 diabetes mellitus – implications for morbidity and mortality. Nat Rev Endocrinol. 2020;16(6):321–331. https://doi.org/10.1038/s41574-020-0334-z.Батрак ГА, Батрак НВ. Течение беременности и родов у женщин с сахарным диабетом 2-го типа и ожирением. Клинический разбор в общей медицине. 2024;5(9):57–61. https://doi.org/10.47407/kr2024.5.9.00479.Batrak GA, Batrak NV. Course of pregnancy and labor in women with type 2 diabetes mellitus and obesity. Clinical Review for General Practice. 2024;5(9):57–61. (In Russ.) https://doi.org/10.47407/kr2024.5.9.00479.Tang O, Matsushita K, Coresh J, Sharrett AR, McEvoy JW, Windham BG et al. Mortality Implications of Prediabetes and Diabetes in Older Adults. Diabetes Care. 2020;43(2):382–388. https://doi.org/10.2337/dc19-1221.Tang O, Matsushita K, Coresh J, Sharrett AR, McEvoy JW, Windham BG et al. Mortality Implications of Prediabetes and Diabetes in Older Adults. Diabetes Care. 2020;43(2):382–388. https://doi.org/10.2337/dc19-1221.Бирюкова ЕВ, Шинкин МВ, Старшинова АА. Предиабет – актуальная медико-социальная проблема современности. Эффективная фармакотерапия. 2023;19(12):42–50. https://doi.org/10.33978/2307-3586-2023-19-12-42-50.Biryukova EV, Shinkin MV, Starshinova AA. Prediabetes is an urgent medical and social problem of our time. Effective Pharmacotherapy. 2023;19(12):42–50. (In Russ.) https://doi.org/10.33978/2307-3586-2023-19-12-42-50.Lu J, He J, Li M, Tang X, Hu R, Shi L et al. Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults. Diabetes Care. 2019;42(8):1539–1548. https://doi.org/10.2337/dc18-1390.Lu J, He J, Li M, Tang X, Hu R, Shi L et al. Predictive Value of Fasting Glucose, Postload Glucose, and Hemoglobin A1c on Risk of Diabetes and Complications in Chinese Adults. Diabetes Care. 2019;42(8):1539–1548. https://doi.org/10.2337/dc18-1390.Моргунова ТБ, Глинкина ИВ, Фадеев ВВ. Преддиабет: проблемы и пути решения. Медицинский совет. 2021;(12):220–227. https://doi.org/10.21518/2079-701X-2021-12-220-227.Morgunova TB, Glinkina IV, Fadeev VV. Prediabetes: challenges and opportunities. Meditsinskiy Sovet. 2021;(12):220–227. (In Russ.) https://doi.org/10.21518/2079-701X-2021-12-220-227.Cai X, Zhang Y, Li M, Wu JH, Mai L, Li J et al. Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis. BMJ. 2020;370:m2297. https://doi.org/10.1136/bmj.m2297.Cai X, Zhang Y, Li M, Wu JH, Mai L, Li J et al. Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis. BMJ. 2020;370:m2297. https://doi.org/10.1136/bmj.m2297.Wang T, Lu J, Su Q, Chen Y, Bi Y, Mu Y et al. Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients With Prediabetes and Diabetes. JAMA Cardiol. 2019;4(9):874–883. https://doi.org/10.1001/jamacardio.2019.2499.Wang T, Lu J, Su Q, Chen Y, Bi Y, Mu Y et al. Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients With Prediabetes and Diabetes. JAMA Cardiol. 2019;4(9):874–883. https://doi.org/10.1001/jamacardio.2019.2499.Аметов АС, Демидова ТЮ, Мкртумян АМ, Дудинская ЕН, Сизова ЕЕ. Вызов современной эндокринологии: поиски комбинированной терапии в условиях инсулинорезистентности (лекция). Эндокринология: новости, мнения, обучение. 2020;9(1):60–69. https://doi.org/10.33029/2304-9529-2020-9-1-60-69.Ametov AS, Demidova TYu, Mkrtumyan AM, Dudinskaya EN, Sizova EE. Challenge in modern endocrinology: search for combined treatment on the back of insulin resistance (lecture). Endocrinology: News, Opinions, Training. 2020;9(1):60–69. (In Russ.) https://doi.org/10.33029/2304-9529-2020-9-1-60-69.Heianza Y, Arase Y, Fujihara K, Tsuji H, Saito K, Hsieh SD et al. Screening for pre-diabetes to predict future diabetes using various cut-off points for HbA(1c) and impaired fasting glucose: the Toranomon Hospital Health Management Center Study 4 (TOPICS 4). Diabet Med. 2012;29(9):e279-85. https://doi.org/10.1111/j.1464-5491.2012.03686.x.Heianza Y, Arase Y, Fujihara K, Tsuji H, Saito K, Hsieh SD et al. Screening for pre-diabetes to predict future diabetes using various cut-off points for HbA(1c) and impaired fasting glucose: the Toranomon Hospital Health Management Center Study 4 (TOPICS 4). Diabet Med. 2012;29(9):e279-85. https://doi.org/10.1111/j.1464-5491.2012.03686.x.DECODE Study Group, on behalf of the European Diabetes Epidemiology Study Group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. DECODE Study Group on behalf of the European Diabetes Epidemiology Study Group. BMJ. 1998;317(7155):371–375. https://doi.org/10.1136/bmj.317.7155.371.DECODE Study Group, on behalf of the European Diabetes Epidemiology Study Group. Will new diagnostic criteria for diabetes mellitus change phenotype of patients with diabetes? Reanalysis of European epidemiological data. DECODE Study Group on behalf of the European Diabetes Epidemiology Study Group. BMJ. 1998;317(7155):371–375. https://doi.org/10.1136/bmj.317.7155.371.Hubbard D, Colantonio LD, Tanner RM, Carson AP, Sakhuja S, Jaeger BC et al. Prediabetes and Risk for Cardiovascular Disease by Hypertension Status in Black Adults: The Jackson Heart Study. Diabetes Care. 2019;42(12):2322–2329. https://doi.org/10.2337/dc19-1074.Hubbard D, Colantonio LD, Tanner RM, Carson AP, Sakhuja S, Jaeger BC et al. Prediabetes and Risk for Cardiovascular Disease by Hypertension Status in Black Adults: The Jackson Heart Study. Diabetes Care. 2019;42(12):2322–2329. https://doi.org/10.2337/dc19-1074.Brannick B, Dagogo-Jack S. Prediabetes and cardiovascular disease: pathophysiology and interventions for prevention and risk reduction. Endocrinol Metab Clin North Am. 2018;47(1):33–50. https://doi.org/10.1016/j.ecl.2017.10.001.Brannick B, Dagogo-Jack S. Prediabetes and cardiovascular disease: pathophysiology and interventions for prevention and risk reduction. Endocrinol Metab Clin North Am. 2018;47(1):33–50. https://doi.org/10.1016/j.ecl.2017.10.001.Kanat M, Mari A, Norton L, Winnier D, DeFronzo RA, Jenkinson C et al. Distinct β-cell defects in impaired fasting glucose and impaired glucose tolerance. Diabetes. 2012;61(2):447–453. https://doi.org/10.2337/db11-0995.Kanat M, Mari A, Norton L, Winnier D, DeFronzo RA, Jenkinson C et al. Distinct β-cell defects in impaired fasting glucose and impaired glucose tolerance. Diabetes. 2012;61(2):447–453. https://doi.org/10.2337/db11-0995.Lindström J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013;56(2):284–293. https://doi.org/10.1007/s00125-012-2752-5.Lindström J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S et al. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia. 2013;56(2):284–293. https://doi.org/10.1007/s00125-012-2752-5.Takao T, Suka M, Yanagisawa H, Iwamoto Y. Impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular events and allcause mortality in patients with type 2 diabetes. J Diabetes Investig. 2017;8(4):600–608. https://doi.org/10.1111/jdi.12610.Takao T, Suka M, Yanagisawa H, Iwamoto Y. Impact of postprandial hyperglycemia at clinic visits on the incidence of cardiovascular events and allcause mortality in patients with type 2 diabetes. J Diabetes Investig. 2017;8(4):600–608. https://doi.org/10.1111/jdi.12610.Madsen KS, Chi Y, Metzendorf MI, Richter B, Hemmingsen B. Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev. 2019;12(12):CD008558. https://doi.org/10.1002/14651858.CD008558.pub2.Madsen KS, Chi Y, Metzendorf MI, Richter B, Hemmingsen B. Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus. Cochrane Database Syst Rev. 2019;12(12):CD008558. https://doi.org/10.1002/14651858.CD008558.pub2.Батрак ГА, Батрак НВ, Жабурина МВ. Сахарный диабет 2-го типа: течение и исходы беременности на примере клинического случая. Медицинский совет. 2024;18(23):118–122. https://doi.org/10.21518/ms2024-549.Batrak GA, Batrak NV, Zhaburina MV. Type 2 diabetes mellitus: course and outcomes of pregnancy on the example of a clinical case. Meditsinskiy Sovet. 2024;18(23):118–122. (In Russ.) https://doi.org/10.21518/ms2024-549.Perreault L, Temprosa M, Mather KJ, Horton E, Kitabchi A, Larkin M et al. Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk: results from the Diabetes Prevention Program outcomes study. Diabetes Care. 2014;37(9):2622–2631. https://doi.org/10.2337/dc14-0656.Perreault L, Temprosa M, Mather KJ, Horton E, Kitabchi A, Larkin M et al. Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk: results from the Diabetes Prevention Program outcomes study. Diabetes Care. 2014;37(9):2622–2631. https://doi.org/10.2337/dc14-0656.Perreault L, Pan Q, Schroeder EB, Kalyani RR, Bray GA, Dagogo-Jack S et al. Regression From Prediabetes to Normal Glucose Regulation and Prevalence of Microvascular Disease in the Diabetes Prevention Program Outcomes Study (DPPOS). Diabetes Care. 2019;42(9):1809–1815. https://doi.org/10.2337/dc19-0244.Perreault L, Pan Q, Schroeder EB, Kalyani RR, Bray GA, Dagogo-Jack S et al. Regression From Prediabetes to Normal Glucose Regulation and Prevalence of Microvascular Disease in the Diabetes Prevention Program Outcomes Study (DPPOS). Diabetes Care. 2019;42(9):1809–1815. https://doi.org/10.2337/dc19-0244.Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. https://doi.org/10.1056/NEJMoa012512.Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. https://doi.org/10.1056/NEJMoa012512.

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