Инсулинотерапия при сахарном диабете 2-го типа: фокус на пациентов пожилого возраста

Распространенность сахарного диабета 2-го типа среди лиц пожилого возраста растет с каждым годом. К основным патогенетическим механизмам СД2 в пожилом возрасте можно отнести нарушение микробиоты кишечника, клеточное старение, окислительный стресс и митохондриальную дисфункцию, а также иммунные и воспалительные процессы. Короткоцепочечные жирные кислоты, продуцируемые микробиотой кишечника, влияют на процессы воспаления в β-клетках поджелудочной железы. Клеточное старение сопровождается секрецией цитокинов, хемокинов, факторов роста и протеаз, усугубляя провоспалительное состояние и усиливая инсулинорезистентность. Окислительный стресс и митохондриальная дисфункция способствуют снижению синтеза АТФ и увеличению образования активных форм кислорода. Изменения в иммунной системе в пожилом возрасте способствуют аутоиммунным процессам и системному воспалению. Клиническими особенностями сахарного диабета в пожилом возрасте являются бессимптомное течение, нарушенное распознавание гипогликемии, нарушение когнитивных функций и мышечная атрофия. Прогрессирующее снижение функции β-клеток при СД2 требует назначения инсулинотерапии многим пациентам. Двухфазные инсулины позволяют контролировать как базальную, так и постпрандиальную гликемию, просты в использовании и показаны к применению у пациентов с размеренным образом жизни, испытываю щих сложности с подсчетом хлебных единиц. Однако стоит помнить о взвешенном подходе к назначению инсулинотерапии и возможности деинтенсификации лечения.

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