Потенциал метформина в снижении веса

Метформин как уникальный противодиабетический препарат первой линии также может быть эффективным в терапии ожирения и связанных с ним метаболических дисфункций. В метаанализах и многочисленных РКИ у лиц с ожирением, с и без сахарного диабета 2-го типа (СД2) при приеме метформина отмечено снижение веса и жировой массы (≈ на 3 кг), а также липидов крови и адипонектина. Механизмы действия метформина по снижению веса, зависимые и независимые от AMP-активируемой протеинкиназы (AMPK): усиление митохондриального биогенеза, уменьшение поглощения жирных кислот за счет подавления передачи сигналов трансформирующего фактора роста-β1 (TGF-β1)/Smad3, модулирования кишечной микробиоты и регулирования ряда других сигналов – фруктозы-1,6-бифосфатазы 1 (FBP1), протеинфосфатазы 2 (PP2A), фактора роста фибробластов 21 (FGF21), сиртуина 1 (SIRT1) и мишени рапамицина (mTOR) и др., подавления экспрессии липогенных генов приводят к снижению потребления энергии. Однако существуют противоположные данные о незначительном влиянии метформина на снижение веса, потребление энергии и состав тела – его эффект варьирует в зависимости от пола, возраста, продолжительности лечения, не обязательно сохраняется после прекращения лечения и существенно не влияет на состав тела. Метформин во всем мире и в РФ пока не включен в список препаратов для лечения ожирения. Необходимы комплексные исследования с достаточной мощностью и более длительным сроком лечения для дальнейшей оценки эффективности и безопасности метформина по снижению и контролю увеличения веса.

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