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

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. 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. 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. 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. 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.

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