Панкреатогенный сахарный диабет/сахарный диабет типа 3с: современное состояние проблемы

Одним из важных условий персонализированного выбора адекватной терапии в современной диабетологии является точный дифференциальный диагноз типа сахарного диабета (СД). Особое внимание в этом плане привлекает вторичный СД вследствие целой группы гетерогенных экзокринных заболеваний поджелудочной железы (ПЖ), объединенных в классификационных целях при разном патогенезе, с лидирующей ролью хронического панкреатита (ХП). В обзоре литературы представлен интегральный взгляд на проблему на основе анализа современных диабетологических и гастроэнтерологических гайдлайнов. Представлена терминологическая трансформация этого диабета в СД типа 3с, обсуждена проблема оценки его распространенности. Рассматриваются клинические особенности в тесной связи с патогенетическими, представляя СД типа 3с как особую морфофункциональную единицу с акцентом на высокий риск протоковой аденокарциномы ПЖ. Обсуждаются сложности его верификации в тесной связи с диагностикой ХП. Отражены подходы к терапии СД типа 3с в зависимости от его конкретной причины с особой значимостью коррекции экзокринной панкреатической недостаточности. Обосновано многообразие клинических подвариантов СД типа 3с с различной степенью нарушений углеводного обмена, что предполагает возможность разных схем сахароснижающей терапии. При отсутствии конкретных алгоритмов рассматриваются принципы управления гипергликемией в сравнении с СД типов 1 и 2: возможности и ограничения неинсулиновых сахароснижающих препаратов и принципы инсулинотерапии.

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