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Лекарственно-индуцированные гипогликемии: фокус на препараты, не относящиеся к группе сахароснижающих лекарственных средств
Остроумова О.Д., Акимова Е.С., Кочетков А.И., Переверзев А.П. Лекарственно-индуцированные гипогликемии: фокус на препараты, не относящиеся к группе сахароснижающих лекарственных средств. Consilium Medicum. 2019; 21 (4): 59–65. DOI: 10.26442/20751753.2019.4.190196
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Ostroumova O.D., Akimova E.S., Kochetkov A.I., Pereverzev A.P. Medically induced hypoglycemia: focus on medications not included in the group of antihyperglycemic medications. Consilium Medicum. 2019; 21 (4): 59–65. DOI: 10.26442/20751753.2019.4.190196
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Аннотация
В последнее время перед врачами встает проблема возникновения у пациентов состояний гипогликемии, вызванных приемом лекарственных средств, которые не являются препаратами для лечения сахарного диабета. Это связано с ростом числа мультиморбидных заболеваний у людей старших возрастных групп и, следовательно, увеличением количества применяемых одновременно препаратов (полипрагмазия). Гипогликемия может осложнить течение сопутствующих заболеваний, способствует возникновению нарушений ритма, повышает риск развития неблагоприятных сердечно-сосудистых событий, когнитивных нарушений, включая деменцию, увеличивает частоту и продолжительность эпизодов ишемии миокарда. К факторам риска развития у пациентов лекарственно-индуцированной гипогликемии относятся: пожилой и старческий возраст; снижение скорости клубочковой фильтрации, печеночная недостаточность (снижение глюконеогенеза), снижение потребления пищи (недостаточное потребление глюкозы); чрезмерное потребление алкоголя (снижение глюконеогенеза, недостаточное потребление пищи); одновременный прием нескольких лекарственных средств, которые могут привести к гипогликемии. Наиболее часто лекарственно-индуцированная гипогликемия развивается на фоне применения фторхинолонов, пентамидина, хинина, β-блокаторов, ингибиторов ангиотензинпревращающего фермента и инсулиноподобного фактора роста (IFG). Главным способом профилактики лекарственно-индуцированной гипогликемии является отказ от его применения и/или замена другим лекарственным средством, не имеющим данного побочного эффекта. Если полностью отказаться от приема препарата невозможно, необходимо свести к минимуму риск гипогликемии следующими способами: использовать длительное введение в организм той же концентрации лекарственного вещества (по возможности пролонгированные формы), cнизить дозу препарата (использовать наименьшую из возможных эффективных доз), контролировать концентрацию глюкозы в крови.
Ключевые слова: гипогликемия, лекарственно-индуцированная гипогликемия, побочные эффекты лекарственных средств, пожилой и старческий возраст.
Ключевые слова: гипогликемия, лекарственно-индуцированная гипогликемия, побочные эффекты лекарственных средств, пожилой и старческий возраст.
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Recently, doctors face the problem of patients with hypoglycemia conditions caused by the use of drugs that are not drugs for the treatment of diabetes. This is due to the increase in the number of multimorbid diseases in people of older age groups and, consequently, an increase in the number of drugs used simultaneously (polypharmacy). Hypoglycemia can complicate the course of concomitant diseases, contributes to the occurrence of arrhythmias, increases the risk of cardiovascular events, cognitive impairment, including dementia, increases the frequency and duration of episodes of myocardial ischemia. Risk factors for the development of drug-induced hypoglycemia include: elderly and senile age; reduced glomerular filtration rate, liver failure (reduced gluconeogenesis), reduced food consumption (insufficient glucose consumption); excessive alcohol consumption (reduced gluconeogenesis, insufficient food intake); simultaneous intake of several drugs that can lead to hypoglycemia. The most frequently drug-induced hypoglycemia develops against the background of the use of quinolones, pentamidine, quinine, β-blockers, angiotensin-converting enzyme inhibitors and insulin-like growth factor. The main vehicle to prevent drug-induced hypoglycemia is to stop its use and/or replace it with another drug that does not have this side effect. If it is impossible to completely abandon the drug, it is necessary to minimize the risk of hypoglycemia in the following ways: use long-term administration of the same concentration of the drug (if possible, prolonged forms), reduce the dose of the drug (use the lowest possible effective doses), control the concentration of glucose in the blood.
Key words: hypoglycemia, drug-induced hypoglycemia, adverse drug reaction, older age.
Key words: hypoglycemia, drug-induced hypoglycemia, adverse drug reaction, older age.
Полный текст
Список литературы
1. Дедов И.И., Шестакова М.В., Викулова О.К. и др. Сахарный диабет в Российской Федерации: распространенность, заболеваемость, смертность, параметры углеводного обмена и структура сахароснижающей терапии по данным Федерального регистра сахарного диабета, статус 2017 г. Сахарный диабет. 2018; 3 (21): 144–59. DOI: 10.14341/DM9686
[Dedov I.I., Shestakova M.V., Vikulova O.K. et al. Sakharnyi diabet v Rossiiskoi Federatsii: rasprostranennost', zabolevaemost', smertnost', parametry uglevodnogo obmena i struktura sakharosnizhaiushchei terapii po dannym Federal'nogo registra sakharnogo diabeta, status 2017 g. Sakharnyi diabet. 2018; 3 (21): 144–59. DOI: 10.14341/DM9686 (in Russian).]
2. Сычев Д.А. Полипрагмазия в клинической практике: проблема и решения. Учебное пособие для врачей. СПб., 2016.
[Sychev D.A. Polipragmaziia v klinicheskoi praktike: problema i resheniia. Uchebnoe posobie dlia vrachei. Saint Petersburg, 2016 (in Russian).]
3. Vue MH, Setter SM. Drug-Induced Glucose Alterations Part 1: Drug-Induced Hypoglycemia. Diabetes Spectrum 2011; 24 (3): 171–7. DOI: 10.2337
4. Pandit M, Burke J, Gustafson A et al. Drug-induced disorders of glucose tolerance. Ann Intern Med 1993; 7: 529–39.
5. Дедов И.И., Шестакова М.В., Майоров А.Ю. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 8-й выпуск. Сахарный диабет. 2017; 20 (1S): 1–121.
[Dedov I.I., Shestakova M.V., Maiorov A.Iu. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. 8-i vypusk. Sakharnyi diabet. 2017; 20 (1S): 1–121 (in Russian).]
6. Helms K, Kelley K. Drug-Induced Hypoglycemia, Hypoglycemia – Causes and Occurrences [online]. 2011; р. 113–30. http://cdn.intechopen.com/pdfswm/21469.pdf
7. Zammit NN, Frier BM. Hypoglycemia in type 2 diabetes. Pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005; 28 (12): 2948–61.
8. Murad M, Coto-Yglesias F, Wang A et al. Drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab 2009; 94 (3): 741–5. DOI: 10,1210
9. Seltzer HS. Drug-induced hypoglycemia. A review of 1418 cases. Endocrinol Metab Clin North Am 1989; 18: 163–1833.
10. Ioannidis JP, Lau J. Completeness of safety reporting in randomized trials: an evaluation of 7 medical areas. JAMA 2001; 285: 437–4434.
11. База данных неблагоприятных побочных реакций ВОЗ VigiBase. http://www.vigiaccess.org (Дата обращения: 17.12.2018).
[Baza dannykh neblagopriiatnykh pobochnykh reaktsii VOZ VigiBase. http://www.vigiaccess.org (Data obrashcheniia: 17.12.2018 (in Russian).]
12. Ferriere M, Lachkar H, Richard JL et al. Captopril and insulin sensitivity [letter]. Ann Intern Med 1985; 102: 134.
13. White J. The contribution of medications to hypoglycemia unawareness. Diabetes Spectrum 2007; 20 (2): 77–80.
14. White JR, Campbell RK. Dangerous and common drug interactions in patients with diabetes mellitus. Endocrinol Metab Clin North Am 2000; 29: 789–802.
15. White JR, Campbell RK. Drug-drug and drug-disease interactions and diabetes. Diabetes Educ 1995; 21: 283–9.
16. Product Information: InnoPran XL oral capsules, propranolol hydrochloride oral capsules. GlaxoSmithKline 2010.
17. Ma RCW, Kong APS, Chan N et al. Drug-induced endocrine and metabolic disorders. Drug Saf 2007; 30: 215–45.
18. Thomson Reuters Healthcare: Micromedex Healthcare Series. Greenwood Village, Colo., Thomson Reuters Healthcare, 2011. 11.12.2018. http://www.micromedex.com/products/hcs
19. Product Information: Pentam 300 IV, IM injection, pentamidine isethionate IV, IM injection. American Pharmaceutical Partners 2008.
20. Product Information: Nebupent inhalation solution, pentamidine isethionate inhalation solution. American Pharmaceutical Partners 2018.
21. Cryer PE, Axelrod L, Grossman AB et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94: 709–28.
22. Maeda N, Tamagawa T, Niki I et al. Increase in insulin release by rat pancreatic islets by quinolone antibiotics. Br J Pharmacol 1996; 117: 372–6.
23. Frothingham R. Glucose homeostasis abnormalities associated with use of gatifloxacin. Clin Infect Dis 2005; 41(9): 1269–76.
24. Gajjar D, LaCreta F, Kollia G et al. Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise. Pharmacotherapy 2000; 20 (6): 76–86.
25. Park-Wyllie L, Juurlink D, Kopp A et al. Outpatient gatifloxacin therapy and dysglycemia in older adults. N Engl J Med 2006; 354 (25): 1352–61.
26. Product Information: Tequin oral tablets, injection, gatifloxacin oral tablets, injection. Bristol-Myers Squibb Company, 2011.
27. Greenberg AL, Decerbo M, Fan J. Gatifloxacin therapy associated with hypogly-cemia. Clin Infect Dis 2005; 40: 1210–1.
28. Goldfine AB, Fonseca V, Jablonski KA et al. The effects of salsalate on glycemic control in patients with type 2 diabetes: a randomized trial. Ann Intern Med 2005; 152: 346–57.
29. Hundal RS, Petersen KF, Mayerson AB et al. Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes. J Clin Invest 2002; 109: 1321–6.
30. Product Information: Indocin intravenous injection, indomethacin intravenous injection. Lundbeck Inc, 2010.
31. Hosono S, Ohno T, Kimoto H et al. Reduction in blood glucose values following indomethacin therapy for patent ductus arteriosus. Pediatr Int 1999; 41 (5): 525–8.
32. Product Information: Qualaquin oral capsules, quinine sulfate oral capsules. AR Scientific Inc, 2010.
33. Field JB, Williams HE, Mortimore GE. Studies on the mechanism of ethanol-induced hypoglycemia. J Clin Invest 1962; 42 (4): 497–506.
34. Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health 1999; 23 (1): 40–54.
35. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care 2003; 26 (3): 1902–12.
[Dedov I.I., Shestakova M.V., Vikulova O.K. et al. Sakharnyi diabet v Rossiiskoi Federatsii: rasprostranennost', zabolevaemost', smertnost', parametry uglevodnogo obmena i struktura sakharosnizhaiushchei terapii po dannym Federal'nogo registra sakharnogo diabeta, status 2017 g. Sakharnyi diabet. 2018; 3 (21): 144–59. DOI: 10.14341/DM9686 (in Russian).]
2. Сычев Д.А. Полипрагмазия в клинической практике: проблема и решения. Учебное пособие для врачей. СПб., 2016.
[Sychev D.A. Polipragmaziia v klinicheskoi praktike: problema i resheniia. Uchebnoe posobie dlia vrachei. Saint Petersburg, 2016 (in Russian).]
3. Vue MH, Setter SM. Drug-Induced Glucose Alterations Part 1: Drug-Induced Hypoglycemia. Diabetes Spectrum 2011; 24 (3): 171–7. DOI: 10.2337
4. Pandit M, Burke J, Gustafson A et al. Drug-induced disorders of glucose tolerance. Ann Intern Med 1993; 7: 529–39.
5. Дедов И.И., Шестакова М.В., Майоров А.Ю. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. 8-й выпуск. Сахарный диабет. 2017; 20 (1S): 1–121.
[Dedov I.I., Shestakova M.V., Maiorov A.Iu. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. 8-i vypusk. Sakharnyi diabet. 2017; 20 (1S): 1–121 (in Russian).]
6. Helms K, Kelley K. Drug-Induced Hypoglycemia, Hypoglycemia – Causes and Occurrences [online]. 2011; р. 113–30. http://cdn.intechopen.com/pdfswm/21469.pdf
7. Zammit NN, Frier BM. Hypoglycemia in type 2 diabetes. Pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005; 28 (12): 2948–61.
8. Murad M, Coto-Yglesias F, Wang A et al. Drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab 2009; 94 (3): 741–5. DOI: 10,1210
9. Seltzer HS. Drug-induced hypoglycemia. A review of 1418 cases. Endocrinol Metab Clin North Am 1989; 18: 163–1833.
10. Ioannidis JP, Lau J. Completeness of safety reporting in randomized trials: an evaluation of 7 medical areas. JAMA 2001; 285: 437–4434.
11. База данных неблагоприятных побочных реакций ВОЗ VigiBase. http://www.vigiaccess.org (Дата обращения: 17.12.2018).
[Baza dannykh neblagopriiatnykh pobochnykh reaktsii VOZ VigiBase. http://www.vigiaccess.org (Data obrashcheniia: 17.12.2018 (in Russian).]
12. Ferriere M, Lachkar H, Richard JL et al. Captopril and insulin sensitivity [letter]. Ann Intern Med 1985; 102: 134.
13. White J. The contribution of medications to hypoglycemia unawareness. Diabetes Spectrum 2007; 20 (2): 77–80.
14. White JR, Campbell RK. Dangerous and common drug interactions in patients with diabetes mellitus. Endocrinol Metab Clin North Am 2000; 29: 789–802.
15. White JR, Campbell RK. Drug-drug and drug-disease interactions and diabetes. Diabetes Educ 1995; 21: 283–9.
16. Product Information: InnoPran XL oral capsules, propranolol hydrochloride oral capsules. GlaxoSmithKline 2010.
17. Ma RCW, Kong APS, Chan N et al. Drug-induced endocrine and metabolic disorders. Drug Saf 2007; 30: 215–45.
18. Thomson Reuters Healthcare: Micromedex Healthcare Series. Greenwood Village, Colo., Thomson Reuters Healthcare, 2011. 11.12.2018. http://www.micromedex.com/products/hcs
19. Product Information: Pentam 300 IV, IM injection, pentamidine isethionate IV, IM injection. American Pharmaceutical Partners 2008.
20. Product Information: Nebupent inhalation solution, pentamidine isethionate inhalation solution. American Pharmaceutical Partners 2018.
21. Cryer PE, Axelrod L, Grossman AB et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94: 709–28.
22. Maeda N, Tamagawa T, Niki I et al. Increase in insulin release by rat pancreatic islets by quinolone antibiotics. Br J Pharmacol 1996; 117: 372–6.
23. Frothingham R. Glucose homeostasis abnormalities associated with use of gatifloxacin. Clin Infect Dis 2005; 41(9): 1269–76.
24. Gajjar D, LaCreta F, Kollia G et al. Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise. Pharmacotherapy 2000; 20 (6): 76–86.
25. Park-Wyllie L, Juurlink D, Kopp A et al. Outpatient gatifloxacin therapy and dysglycemia in older adults. N Engl J Med 2006; 354 (25): 1352–61.
26. Product Information: Tequin oral tablets, injection, gatifloxacin oral tablets, injection. Bristol-Myers Squibb Company, 2011.
27. Greenberg AL, Decerbo M, Fan J. Gatifloxacin therapy associated with hypogly-cemia. Clin Infect Dis 2005; 40: 1210–1.
28. Goldfine AB, Fonseca V, Jablonski KA et al. The effects of salsalate on glycemic control in patients with type 2 diabetes: a randomized trial. Ann Intern Med 2005; 152: 346–57.
29. Hundal RS, Petersen KF, Mayerson AB et al. Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes. J Clin Invest 2002; 109: 1321–6.
30. Product Information: Indocin intravenous injection, indomethacin intravenous injection. Lundbeck Inc, 2010.
31. Hosono S, Ohno T, Kimoto H et al. Reduction in blood glucose values following indomethacin therapy for patent ductus arteriosus. Pediatr Int 1999; 41 (5): 525–8.
32. Product Information: Qualaquin oral capsules, quinine sulfate oral capsules. AR Scientific Inc, 2010.
33. Field JB, Williams HE, Mortimore GE. Studies on the mechanism of ethanol-induced hypoglycemia. J Clin Invest 1962; 42 (4): 497–506.
34. Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health 1999; 23 (1): 40–54.
35. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care 2003; 26 (3): 1902–12.
________________________________________________
1. Dedov I.I., Shestakova M.V., Vikulova O.K. et al. Sakharnyi diabet v Rossiiskoi Federatsii: rasprostranennost', zabolevaemost', smertnost', parametry uglevodnogo obmena i struktura sakharosnizhaiushchei terapii po dannym Federal'nogo registra sakharnogo diabeta, status 2017 g. Sakharnyi diabet. 2018; 3 (21): 144–59. DOI: 10.14341/DM9686 (in Russian).
2. Sychev D.A. Polipragmaziia v klinicheskoi praktike: problema i resheniia. Uchebnoe posobie dlia vrachei. Saint Petersburg, 2016 (in Russian).
3. Vue MH, Setter SM. Drug-Induced Glucose Alterations Part 1: Drug-Induced Hypoglycemia. Diabetes Spectrum 2011; 24 (3): 171–7. DOI: 10.2337
4. Pandit M, Burke J, Gustafson A et al. Drug-induced disorders of glucose tolerance. Ann Intern Med 1993; 7: 529–39.
5. Dedov I.I., Shestakova M.V., Maiorov A.Iu. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. 8-i vypusk. Sakharnyi diabet. 2017; 20 (1S): 1–121 (in Russian).
6. Helms K, Kelley K. Drug-Induced Hypoglycemia, Hypoglycemia – Causes and Occurrences [online]. 2011; р. 113–30. http://cdn.intechopen.com/pdfswm/21469.pdf
7. Zammit NN, Frier BM. Hypoglycemia in type 2 diabetes. Pathophysiology, frequency, and effects of different treatment modalities. Diabetes Care 2005; 28 (12): 2948–61.
8. Murad M, Coto-Yglesias F, Wang A et al. Drug-induced hypoglycemia: a systematic review. J Clin Endocrinol Metab 2009; 94 (3): 741–5. DOI: 10,1210
9. Seltzer HS. Drug-induced hypoglycemia. A review of 1418 cases. Endocrinol Metab Clin North Am 1989; 18: 163–1833.
10. Ioannidis JP, Lau J. Completeness of safety reporting in randomized trials: an evaluation of 7 medical areas. JAMA 2001; 285: 437–4434.
11. Baza dannykh neblagopriiatnykh pobochnykh reaktsii VOZ VigiBase. http://www.vigiaccess.org (Data obrashcheniia: 17.12.2018 (in Russian).
12. Ferriere M, Lachkar H, Richard JL et al. Captopril and insulin sensitivity [letter]. Ann Intern Med 1985; 102: 134.
13. White J. The contribution of medications to hypoglycemia unawareness. Diabetes Spectrum 2007; 20 (2): 77–80.
14. White JR, Campbell RK. Dangerous and common drug interactions in patients with diabetes mellitus. Endocrinol Metab Clin North Am 2000; 29: 789–802.
15. White JR, Campbell RK. Drug-drug and drug-disease interactions and diabetes. Diabetes Educ 1995; 21: 283–9.
16. Product Information: InnoPran XL oral capsules, propranolol hydrochloride oral capsules. GlaxoSmithKline 2010.
17. Ma RCW, Kong APS, Chan N et al. Drug-induced endocrine and metabolic disorders. Drug Saf 2007; 30: 215–45.
18. Thomson Reuters Healthcare: Micromedex Healthcare Series. Greenwood Village, Colo., Thomson Reuters Healthcare, 2011. 11.12.2018. http://www.micromedex.com/products/hcs
19. Product Information: Pentam 300 IV, IM injection, pentamidine isethionate IV, IM injection. American Pharmaceutical Partners 2008.
20. Product Information: Nebupent inhalation solution, pentamidine isethionate inhalation solution. American Pharmaceutical Partners 2018.
21. Cryer PE, Axelrod L, Grossman AB et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2009; 94: 709–28.
22. Maeda N, Tamagawa T, Niki I et al. Increase in insulin release by rat pancreatic islets by quinolone antibiotics. Br J Pharmacol 1996; 117: 372–6.
23. Frothingham R. Glucose homeostasis abnormalities associated with use of gatifloxacin. Clin Infect Dis 2005; 41(9): 1269–76.
24. Gajjar D, LaCreta F, Kollia G et al. Effect of multiple-dose gatifloxacin or ciprofloxacin on glucose homeostasis and insulin production in patients with noninsulin-dependent diabetes mellitus maintained with diet and exercise. Pharmacotherapy 2000; 20 (6): 76–86.
25. Park-Wyllie L, Juurlink D, Kopp A et al. Outpatient gatifloxacin therapy and dysglycemia in older adults. N Engl J Med 2006; 354 (25): 1352–61.
26. Product Information: Tequin oral tablets, injection, gatifloxacin oral tablets, injection. Bristol-Myers Squibb Company, 2011.
27. Greenberg AL, Decerbo M, Fan J. Gatifloxacin therapy associated with hypogly-cemia. Clin Infect Dis 2005; 40: 1210–1.
28. Goldfine AB, Fonseca V, Jablonski KA et al. The effects of salsalate on glycemic control in patients with type 2 diabetes: a randomized trial. Ann Intern Med 2005; 152: 346–57.
29. Hundal RS, Petersen KF, Mayerson AB et al. Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes. J Clin Invest 2002; 109: 1321–6.
30. Product Information: Indocin intravenous injection, indomethacin intravenous injection. Lundbeck Inc, 2010.
31. Hosono S, Ohno T, Kimoto H et al. Reduction in blood glucose values following indomethacin therapy for patent ductus arteriosus. Pediatr Int 1999; 41 (5): 525–8.
32. Product Information: Qualaquin oral capsules, quinine sulfate oral capsules. AR Scientific Inc, 2010.
33. Field JB, Williams HE, Mortimore GE. Studies on the mechanism of ethanol-induced hypoglycemia. J Clin Invest 1962; 42 (4): 497–506.
34. Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health 1999; 23 (1): 40–54.
35. Cryer PE, Davis SN, Shamoon H. Hypoglycemia in diabetes. Diabetes Care 2003; 26 (3): 1902–12.
Авторы
О.Д.Остроумова*1,2, Е.С.Акимова2, А.И.Кочетков1, А.П.Переверзев1
1 ОСП «Российский геронтологический научно-клинический центр» – ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России, Москва, Россия;
1 ОСП «Российский геронтологический научно-клинический центр» – ФГБОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И.Пирогова» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И.Евдокимова» Минздрава России, Москва, Россия
*ostroumova.olga@mail.ru
*ostroumova.olga@mail.ru
________________________________________________
Olga D. Ostroumova*1,2, Elizaveta S. Akimova2, Aleksei I. Kochetkov1, Anton P. Pereverzev1
1 Russian Clinical and Research Center of Gerontology – Pirogov Russian National Research Medical University, Moscow, Russia;
1 Russian Clinical and Research Center of Gerontology – Pirogov Russian National Research Medical University, Moscow, Russia;
2 A.I.Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*ostroumova.olga@mail.ru
*ostroumova.olga@mail.ru
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