Современные представления о фенотипах сахарного диабета 2-го типа

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.

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