medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-396medsovet-9557Research ArticleСАХАРНЫЙ ДИАБЕТDIABETES MELLITUSСовременные представления о фенотипах сахарного диабета 2-го типаModern concepts of type 2 diabetes mellitus phenotypeshttps://orcid.org/0000-0001-8959-093XКиселеваТ. А.KiselevaT. A.

Киселева Татьяна Александровна, к.м.н., доцент кафедры эндокринологии

420012, Россия, Казань, ул. Бутлерова, д. 49

Tatiana A. Kiseleva, Cand. Sci. (Med.), Associate Professor of the Department of Endocrinology

49, Butlerov St., Kazan, 420012, Russia

tattiana@mail.ruhttps://orcid.org/0000-0001-6000-8002ВалееваФ. В.ValeevaF. V.

Валеева Фарида Вадутовна, д.м.н., профессор, заведующая кафедрой эндокринологии

420012, Россия, Казань, ул. Бутлерова, д. 49

Farida V. Valeeva, Dr. Sci. (Med.), Professor, Head of the Department of Endocrinology

49, Butlerov St., Kazan, 420012, Russia

val_farida@mail.ruhttps://orcid.org/0000-0003-3639-6361ИсламоваД. Р.IslamovaD. R.

Исламова Диана Рамилевна, аспирант кафедры эндокринологии

420012, Россия, Казань, ул. Бутлерова, д. 49

Diana R. Islamova, Postgraduate Student of the Department of Endocrinology

49, Butlerov St., Kazan, 420012, Russia

radiana2007@yandex.ruhttps://orcid.org/0000-0001-5942-5335НабиуллинаР. М.NabiullinaR. M.

Набиуллина Роза Муллаяновна, к.м.н., доцент кафедры биохимии и клинической лабораторной диагностики

420012, Россия, Казань, ул. Бутлерова, д. 49

Rosa M. Nabiullina, Cand. Sci. (Med.), Assistant Professor of the Department of Biochemistry and Clinical Laboratory Diagnostics

49, Butlerov St., Kazan, 420012, Russia

nabiullina.rosa@yandex.ruКазанский государственный медицинский университетРоссияKazan State Medical UniversityRussian Federation202520112025016169–176Copyright © Киселева Т.А., Валеева Ф.В., Исламова Д.Р., Набиуллина Р.М., 20252025Киселева Т.А., Валеева Ф.В., Исламова Д.Р., Набиуллина Р.М.Kiseleva T.A., Valeeva F.V., Islamova D.R., Nabiullina R.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/9557

В условиях стремительного роста распространенности сахарного диабета 2-го типа особое значение приобретает изучение фенотипической гетерогенности заболевания, обусловленной вариабельностью патофизиологических процессов, воздействием факторов окружающей среды и индивидуальной генетической предрасположенностью. Традиционное деление на сахарный диабет 1-го и 2-го типов не отражает всей сложности патогенеза и многообразия клинических подтипов сахарного диабета 2-го типа. Современные исследования выявляют устойчивые подгруппы пациентов с различными клиническими траекториями развития заболевания, что в перспективе потребует пересмотра диагностических и лечебных подходов. В рамках данной обзорной статьи проведен анализ исследований, посвященных стратификации пациентов с сахарным диабетом 2-го типа. Раскрываются ключевые особенности наиболее воспроизводимых фенотипов, включая тяжелый инсулинодефицитный диабет (SIDD), тяжелый инсулинорезистентный диабет (SIRD), легкий диабет, связанный с ожирением (MOD), легкий диабет, связанный с возрастом (MARD), и тяжелый аутоиммунный диабет (SAID), приводятся их патофизиологические характеристики, клинические особенности, терапевтические стратегии и подходы к профилактике диабетических осложнений в различных подгруппах. В независимых когортных исследованиях подтверждены стабильные ассоциации выделенных фенотипов с ключевыми клиническими исходами, включая степень гликемического контроля, частоту развития микрососудистых и макрососудистых осложнений, а также показатели смертности, что в перспективе может использоваться для разработки персонализированных стратегий ведения пациентов. Тем не менее требуются дальнейшие исследования, направленные на валидацию и оптимизацию методов подклассификации сахарного диабета 2-го типа, для обоснованного внедрения новых лечебно-диагностических алгоритмов в повседневную клиническую практику.

In the context of the rapid increase in the prevalence of type 2 diabetes mellitus, the study of the phenotypic heterogeneity of the disease, caused by the variability of pathophysiological processes, the impact of environmental factors and individual genetic predisposition, is of particular importance. The traditional division into diabetes mellitus types 1 and 2 does not reflect the entire complexity of the pathogenesis and the diversity of clinical subtypes of type 2 diabetes mellitus. Modern studies reveal stable subgroups of patients with different clinical trajectories of disease development, which in the future will require a revision of diagnostic and therapeutic approaches. This review article analyzes studies devoted to the stratification of patients with type 2 diabetes mellitus. The key features of the most reproducible phenotypes, including severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), mild age-related diabetes (MARD), and severe autoimmune diabetes (SAID), are disclosed, their pathophysiological characteristics, clinical features, therapeutic strategies, and approaches to the prevention of diabetic complications in various subgroups are given. Independent cohort studies have confirmed stable associations of the identified phenotypes with key clinical outcomes, including the degree of glycemic control, the incidence of microvascular and macrovascular complications, and mortality rates, which can be used in the future to develop personalized patient management strategies. However, further studies are required to validate and optimize the methods for subclassifying type 2 diabetes mellitus for the justified implementation of new treatment and diagnostic algorithms in everyday clinical practice.

гетерогенность сахарного диабета 2-го типакластерыстратификацияинсулинорезистентностьдисфункция β-клетокперсонализированная медицинаheterogeneity of type 2 diabetes mellitusclustersstratificationinsulin resistanceβ-cell dysfunctionpersonalized medicineРабота выполнена за счет гранта Академии наук Республики Татарстан, предоставленного молодым кандидатам наук (постдокторантам) с целью защиты докторской диссертации, выполнения научно-исследовательских работ, а также трудовых функций в научных и образовательных организациях Республики Татарстан в рамках Государственной программы Республики Татарстан «Научно-технологическое развитие Республики Татарстан» (соглашение №131/2024-ПД).The work was carried out with the support of a grant from the Academy of Sciences of the Republic of Tatarstan, provided to young candidates of science (postdoctoral students) for the purpose of defending a doctoral dissertation, carrying out research work, and also performing work functions in scientific and educational organizations of the Republic of Tatarstan Scientific and Technical Development of the Republic of Tatarstan (Agreement No. 131/2024-PD).ReferencesMagliano DJ, Boyko EJ, Ali MK, Anstey K, Booth G, Duncan BB et al. 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The authors declare that there are no conflicts of interest present.