Сахарный диабет типа 2 является не только хроническим заболеванием, но и относится к группе постоянно прогрессирующих патологий. Независимо от уровня развития медицины и используемых терапевтических подходов, смертность от сердечно-сосудистых осложнений при сахарном диабете превышает показатели общей популяции. По результатам исследования Veterans Affairs Diabetes Trial было выявлено, что тяжелые гипогликемии являются предикторами развития инфаркта миокарда и острого нарушения мозгового кровообращения. Залогом успешного лечения пациентов с сахарным диабетом типа 2 являются адекватный выбор целевых значений гликемии и поддержание его посредством сочетания лечебных (соблюдение диетологических рекомендаций, прием сахароснижающих препаратов и др.) и немедикаментозных (в первую очередь активный самоконтроль гликемии) мероприятий.
Diabetes mellitus type 2 is not only a chronic disease, but also refers to a group of constantly progressing pathologies. Regardless of the level of development of medicine and used therapeutic approaches, mortality from cardio-vascular complications of diabetes exceeds the figures of the General population. According to the results of Veterans Affairs Diabetes Trial it was revealed that severe hypoglycemia are predictors for the development of myocardial infarction and acute disturbance of cerebral blood circulation. Pledge of successful treatment of patients with type 2 diabetes is the adequate choice of target values of glycemia and maintaining it by means of a combination of curative (observance of dietary recommendations, reception of hypoglycemic drugs, etc.) and not drug-induced (by which primarily active self-monitoring of blood glucose) activities.
Key words: diabetes type 2, hypoglycemia, self-control, НbА1C, cardiovascular diseases.
1. Antman EM, Tanasijevic MJ, Thompson B et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. NEJM 1996; 335 (18): 1342–9.
2. Balkau B, Simon D. Survival in people with type 2 diabetes as a function of HbA(1c). Lancet 2010; 375 (9713): 438–40.
3. Balkau B.New diagnostic criteria for diabetes and mortality in older adults. DECODE Study Group. European Diabetes Epidemiology Group. Lancet 1999; 353 (9146): 68–9.
4. Becker A, Bos G, Vegt F et al. Cardiovascular events in type 2 diabetes: comparison with nondiabetic individuals without and with prior cardiovascular disease. 10-year follow-up of the Hoorn Study. Eur Heart J 2003; 24 (15): 1406–13.
5. Lee CD, Folsom AR, Pankow JS et al. Cardiovascular events in diabetic and nondiabetic adults with or without history of myocardial infarction. Circulation 2004; 109 (7): 855–60.
6. Nathan DM, Buse JB, Davidson MB et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the study of Diabetes. Diabetes Care 2009; 32 (1): 193–203.
7. Selvin E, Marinopoulos S, Berkenblit G et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141 (6): 421–31.
8. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837–53.
9. Ohkubo Y, Kishikawa H, Araki E et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28 (2): 103–17.
10. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. NEJM 2008; 358: 2560–72.
11. Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type 2 diabetes. NEJM 2009; 360 (2): 129–39.
12. Meinert CL, Knatterud GL, Prout TE, Klimt CR. A study of the effects of hypoglycemic agents on vascular complications in patients with adult-onset diabetes. II. Mortality results. Diabetes 1970; 19 (Suppl. 2): 789–830.
13. ADA, Standards of Medical Care in Diabetes – 2011. Diabetes Care 2011; 34 (Suppl. 1).
14. Amiel S A, Dixon T, Mann R, Jameson K. Hypoglycaemia in type 2 diabetes. Diabet Med 2008; 25: 245–54.
15. Доскина Е.В. Эндокринологические эпонимические синдромы и симптомы. М.: Энциклопедия, 2008.
16. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под ред. И.И.Дедова, М.В.Шестаковой. М., 2011; с. 9.
17. Raine CH, Schrock LE, Edelman SV, Mudaliar SRD et al. Significant insulin dose errors may occur if blood glucose results are obtained from miscoded meters. J Diabetes Science Technology 2007; 1: 205–10.
Авторы
Е.В.Доскина*1, Б.М.Танхилевич2
1 ГБОУ ДПО Российская медицинская академия последипломного образования Минздрава РФ, Москва;
2 ГУЗ ГКБ им. С.П.Боткина ДЗ г. Москвы
*Elena-doskina@rambler.ru
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E.V.Doskina*1, B.M.Tankhilevich2
1 Russian Medical Academy of Postgraduate Education, Ministry of Health of* the Russian Federation, Moscow
2 S.P.Botkin City Clinical Hospital, Moscow Healthcare Department
*Elena-doskina@rambler.ru