Взаимосвязь развития метаболических нарушений и инсулинорезистентности у пациентов с сахарным диабетом
Взаимосвязь развития метаболических нарушений и инсулинорезистентности у пациентов с сахарным диабетом
Дорофеева Г.Б., Дорофеев И.В. Взаимосвязь развития метаболических нарушений и инсулинорезистентности у пациентов с сахарным диабетом. Consilium Medicum. 2015; 17 (10): 77–80. DOI:10.26442/2075-1753_2015.10.77-80
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Dorofeeva G.B., Dorofeev I.V. The relationship between metabolic disorders and insulin resistance in patients with diabetes mellitus. Consilium Medicum. 2015; 17 (10): 77–80. DOI:10.26442/2075-1753_2015.10.77-80
Взаимосвязь развития метаболических нарушений и инсулинорезистентности у пациентов с сахарным диабетом
Дорофеева Г.Б., Дорофеев И.В. Взаимосвязь развития метаболических нарушений и инсулинорезистентности у пациентов с сахарным диабетом. Consilium Medicum. 2015; 17 (10): 77–80. DOI:10.26442/2075-1753_2015.10.77-80
________________________________________________
Dorofeeva G.B., Dorofeev I.V. The relationship between metabolic disorders and insulin resistance in patients with diabetes mellitus. Consilium Medicum. 2015; 17 (10): 77–80. DOI:10.26442/2075-1753_2015.10.77-80
Сахарный диабет (СД) – это гетерогенная группа метаболических расстройств, характеризующаяся гипергликемией, микро- и сердечно-сосудистыми осложнениями. По данным Международной федерации диабета (International Diabetes Federation – IDF), число больных СД прогрессивно увеличивается. Ежегодно СД развивается у 7 млн человек, и ежегодно 3,8 млн умирают от причин, связанных с СД.
Наиболее значимым фактором, ведущим к повреждению сердечной мышцы при СД, cтановится гипергликемия, способствующая поражению миокарда. В настоящее время механизмы эндотелиальной дисфункции при СД связаны с уменьшением синтеза и усилением распада ангиопротективного фактора – оксида азота вследствие оксидативного стресса. Доказано существование еще одного мощного фактора, ухудшающего кардиальный прогноз пациентов с СД, – диабетической кардиомиопатии. Длительное течение СД приводит к развитию не только атеросклероза коронарных артерий, диабетической кардимиопатии, но и вегетативной нейропатии сердца и сосудов. Многими исследованиями было доказано, что нарушения в секреции инсулина и чувствительности к нему становятся важными детерминантами СД и нарушенной толерантности к глюкозе. Достижение целевых уровней гликемии, близких к недиабетическому статусу, приводит к значительному снижению развития микро- и макрососудистых осложнений.
Ключевые слова: сахарный диабет, инсулинорезистентность, сердечно-сосудистые заболевания, дисфункция эндотелия, диабетическая кардиомиопатия, вегетативная нейропатия сердца и сосудов, контроль гликемии.
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Diabetes mellitus (DM) is a heterogeneous group of metabolic disorder characterized by hyperglycemia, micro- and cardiovascular complications. According to the data of International Diabetes Federation (IDF), the number of patients with DM has been progressively increasing. DM can be determined in 7 million people and 3.8 million of them die annually from the causes associated with DM. The most significant factor leading to heart muscle damage in case of DM is hyperglycemia that can damage the myocardium. The mechanisms of endothelial dysfunction in patients with DM are associated with the synthesis reduction and the amplification of the angioprotective factor disintegration (nitric oxide) due to oxidative stress, nowadays. There is an existence of another important factor – diabetic cardiomyopathy, which can affect the cardiac prognosis in patients with DM. Long-lasting DM leads not only to the development of coronary arteries atherosclerosis, diabetic cardiomyopathy, but also to autonomic neuropathy affecting the heart and blood vessels. Many studies showed that disinsulinism and impaired insulin sensitivity were important determinants of DM and impaired glucose tolerance. The achievement of target glycemic levels close to nondiabetic status would bring to the significant reduction of the micro- and macrovascular complications development.
Key words: diabetes mellitus, insulin resistance, cardiovascular disease, dysfunction of endothelium, diabetic cardiomyopathy, vegetal autonomic neuropathy involving the heart and blood vessels, control of glycemia.
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6. Lewis HK, Velentgas P, Brazilin J. Cardiovascular Disease and Risk of Incident Cardiovascular Disease and All-Cause Mortality. Arterioscler Thromb Vasc Biol 2000; 20: 823–9.
7. Kuller L, Borhani N, Furberg C et al. Prevalence of subclinical atherosclerosis and cardiovascular disease and association with risk factors in the Cardiovascular Health Study. Am J Epidemiol 1994; 139: 1164–79.
8. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol Endocrinol Metab 1979; 237: E214–E223.
9. Соколов Е.И. Диабетическое сердце. М., 2002; с. 64–5; 68, 330–54; 416. / Sokolov E.I. Diabeticheskoe serdtse. M., 2002; s. 64–5; 68, 330–54; 416. [in Russian]
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12. Касаткина С.Г., Касаткин С.Н. Значение дисфункции эндотелия у больных сахарным диабетом 2-го типа. Мед. науки. 2011; 7: 248–25. / Kasatkina S.G., Kasatkin S.N. Znachenie disfunktsii endoteliia u bol'nykh sakharnym diabetom 2-go tipa. Med. nauki. 2011; 7: 248–25. [in Russian]
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15. Storey AM, Perry CJ, Petrie JR. Endothelial dysfunction in type 2 diabetes. Br J Diab Vasc Dis 2001; 1 (Issue 1): 22–7.
16. Hubbard AK, Rothlein R. Intercellular adhesion molecule-1 (ICAM-1) expression and cell signaling cascades. Free Radical Biol Med 2000; 28: 1379–86.
17. Шестакова М.В. Дисфункция эндотелия – причина или следствие метаболического синдрома? РМЖ. 2001; 9: 22–6. / Shestakova M.V. Disfunktsiia endoteliia – prichina ili sledstvie metabolicheskogo sindroma? RMZh. 2001; 9: 22–6. [in Russian]
18. Гуревич М.А. Особенности патогенеза и лечения ишемической болезни сердца, сердечной недостаточности и артериальной гипертонии у больных сахарным диабетом. Клин. медицина. 2005; 1: 4–9. / Gurevich M.A. Osobennosti patogeneza i lecheniia ishemicheskoi bolezni serdtsa, serdechnoi nedostatochnosti i arterial'noi gipertonii u bol'nykh sakharnym diabetom. Klin. meditsina. 2005; 1: 4–9. [in Russian]
19. Шкляева Л.Н. Особенности вегетативной регуляции у больных артериальной гипертензией с ортостатическими нарушениями на фоне сахарного диабета 2 типа. Автореф. дис. … канд. мед. наук. Пермь, 2004. / Shkliaeva L.N. Osobennosti vegetativnoi reguliatsii u bol'nykh arterial'noi gipertenziei s ortostaticheskimi narusheniiami na fone sakharnogo diabeta 2 tipa. Avtoref. dis. … kand. med. nauk. Perm', 2004. [in Russian]
20. Соколов Е.И. Диабетическое сердце. М., 2002; с. 64–5; 68; 330–54; 416. / Sokolov E.I. Diabeticheskoe serdtse. M., 2002; s. 64–5; 68; 330–54; 416. [in Russian]
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22. Cobelli C, Toffolo GM et al. Assessment of b-cell function in humans, simultaneously with insulin sensitivity and hepatic extraction, from intravenous and oral glucose tests. Am J Physiol Endocrinol Metab 2007; 293: E1-E15.
23. Dalla Man C, Caumo A, Cobelli C. The oral glucose minimal model: estimation of insulin sensitivity from a meal test. IEEE Trans Biomed Eng 2002; 49: 419–29.
24. Bergman RN, Ider YZ, Bowden CR, Cobelli C. Quantitative estimation of insulin sensitivity. Am J Physiol Endocrinol Metab Gastrointest Physiol 1979; 236: E667–E677.
25. Toffolo G, Campioni M, Basu R et al. A minimal model of insulin secretion and kinetics to assess hepatic insulin extraction. Am J Physiol Endocrinol Metab 2006; 290: E169–E176.
26. Toffolo G, De Grandi F, Cobelli C. Estimation of b-cell sensitivity from intravenous glucose tolerance test C-peptide data. Knowledge of the kinetics avoids errors in modeling the secretion. Diabetes 1995; 44: 845–54.
27. Matthews DR, Hosker JP et al. Homeostasis model assessment: insulin resistance and b-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–9.
28. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004; 27: 1487–95.
29. Katz A, Nambi SS, Mather K et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000; 85: 2402–10.
30. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999; 22: 1462–70.
31. Despres, JP, Lamarche B, Mauriege P et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 1996; 334: 952–7.
32. Facchini, FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age-related diseases. J Clin Endocrinol Metab 2001; 86: 3574–8.
33. Ferrannini, E, Buzzigoli G, Bonadonna R et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350–7.
34. Reaven, GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334: 374–81.
35. Montagnani M, Quon MJ. Insulin action in vascular endothelium: potential mechanisms linking insulin resistance with hypertension. Diabetes Obes Metab 2000; 2: 285–92.
36. Nystrom FH, Quon MJ. Insulin signalling: metabolic pathways and mechanisms for specificity. Cell Signal 1999; 11: 563–74.
37. Kashiwabara H, Inaba M, Maruno Y et al. Insulin levels during fasting and the glucose tolerance test and Homa's index predict subsequent development of hypertension. J Hypertens 2000; 18: 83–8.
38. Holman RR et al. UKPDS 80. N Eng J Med 2008; 359.
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1. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Pod red. I.I.Dedova, M.V.Shestakovoi. 7-e izd. Sakharnyi diabet. 2015; 18 (1S): 1–112. [in Russian]
2. Ametov A.S., Demidova T.Iu., Kosykh S.A. Sintez oksida azota v endotelii sosudov u bol'nykh SD 2-go tipa. Klin. meditsina. 2005; 28: 62–8. [in Russian]
3. Dzhakhangirov T.Sh. Sakharnyi diabet kak problema sovremennoi kardiologii. Kardiologiia. 2005; 10: 55–61. [in Russian]
4. Haffner SM, Lehto S, Ronnemaa T et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. Engl J Med 1998; 339: 229–34.
5. Haffner SM, Stern MP, Hazuda H et al. Cardiovascular risk factors in confirmed prediabetic individuals: does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA 1990; 263: 2893–8.
6. Lewis HK, Velentgas P, Brazilin J. Cardiovascular Disease and Risk of Incident Cardiovascular Disease and All-Cause Mortality. Arterioscler Thromb Vasc Biol 2000; 20: 823–9.
7. Kuller L, Borhani N, Furberg C et al. Prevalence of subclinical atherosclerosis and cardiovascular disease and association with risk factors in the Cardiovascular Health Study. Am J Epidemiol 1994; 139: 1164–79.
8. DeFronzo RA, Tobin JD, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol Endocrinol Metab 1979; 237: E214–E223.
9. Соколов Е.И. Диабетическое сердце. М., 2002; с. 64–5; 68, 330–54; 416. / Sokolov E.I. Diabeticheskoe serdtse. M., 2002; s. 64–5; 68, 330–54; 416. [in Russian]
10. Rodrigues B et al. Metabolic disturbances in diabetic cardiomyopathy. B Mol Cell Biochem 1998; 180 (1–2): 53–7.
11. Nikitina O.V. Variabel'nost' serdechnogo ritma i rezul'taty monitorirovaniia arterial'nogo davleniia u bol'nykh sakharnym diabetom 2 tipa v sochetanii s arterial'noi gipertenziei. Avtoref. dis. … kand. med. nauk. Perm', 2004. [in Russian]
12. Kasatkina S.G., Kasatkin S.N. Znachenie disfunktsii endoteliia u bol'nykh sakharnym diabetom 2-go tipa. Med. nauki. 2011; 7: 248–25. [in Russian]
13. Zateishchikov D.A., Minushkina L.O., Kudriashova O.Iu. Funktsional'noe sootnoshenie endoteliia u bol'nykh AG i IBS. Kardiologiia. 2000; 6: 56–9. [in Russian]
14. Kremneva L.V., Shalaev C.B. Interleikin-6 i molekuly kletochnoi adgezii: sviaz' s faktorami riska i prognozom ishemicheskoi bolezni serdtsa. Klin. farmakologiia i terapiia. 2004; 5: 78–81. [in Russian]
15. Storey AM, Perry CJ, Petrie JR. Endothelial dysfunction in type 2 diabetes. Br J Diab Vasc Dis 2001; 1 (Issue 1): 22–7.
16. Hubbard AK, Rothlein R. Intercellular adhesion molecule-1 (ICAM-1) expression and cell signaling cascades. Free Radical Biol Med 2000; 28: 1379–86.
17. Shestakova M.V. Disfunktsiia endoteliia – prichina ili sledstvie metabolicheskogo sindroma? RMZh. 2001; 9: 22–6. [in Russian]
18. Gurevich M.A. Osobennosti patogeneza i lecheniia ishemicheskoi bolezni serdtsa, serdechnoi nedostatochnosti i arterial'noi gipertonii u bol'nykh sakharnym diabetom. Klin. meditsina. 2005; 1: 4–9. [in Russian]
19. Shkliaeva L.N. Osobennosti vegetativnoi reguliatsii u bol'nykh arterial'noi gipertenziei s ortostaticheskimi narusheniiami na fone sakharnogo diabeta 2 tipa. Avtoref. dis. … kand. med. nauk. Perm', 2004. [in Russian]
20. Sokolov E.I. Diabeticheskoe serdtse. M., 2002; s. 64–5; 68; 330–54; 416. [in Russian]
21. Balabolkin M.I. Rol' okislitel'nogo stressa v patogeneze diabeticheskoi neiropatii i vozmozhnost' ego korrektsii preparatami a-lipoevoi kisloty. Probl. endokrinologii. 2005; 3: 22–33. [in Russian]
22. Cobelli C, Toffolo GM et al. Assessment of b-cell function in humans, simultaneously with insulin sensitivity and hepatic extraction, from intravenous and oral glucose tests. Am J Physiol Endocrinol Metab 2007; 293: E1-E15.
23. Dalla Man C, Caumo A, Cobelli C. The oral glucose minimal model: estimation of insulin sensitivity from a meal test. IEEE Trans Biomed Eng 2002; 49: 419–29.
24. Bergman RN, Ider YZ, Bowden CR, Cobelli C. Quantitative estimation of insulin sensitivity. Am J Physiol Endocrinol Metab Gastrointest Physiol 1979; 236: E667–E677.
25. Toffolo G, Campioni M, Basu R et al. A minimal model of insulin secretion and kinetics to assess hepatic insulin extraction. Am J Physiol Endocrinol Metab 2006; 290: E169–E176.
26. Toffolo G, De Grandi F, Cobelli C. Estimation of b-cell sensitivity from intravenous glucose tolerance test C-peptide data. Knowledge of the kinetics avoids errors in modeling the secretion. Diabetes 1995; 44: 845–54.
27. Matthews DR, Hosker JP et al. Homeostasis model assessment: insulin resistance and b-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–9.
28. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004; 27: 1487–95.
29. Katz A, Nambi SS, Mather K et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000; 85: 2402–10.
30. Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999; 22: 1462–70.
31. Despres, JP, Lamarche B, Mauriege P et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease. N Engl J Med 1996; 334: 952–7.
32. Facchini, FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age-related diseases. J Clin Endocrinol Metab 2001; 86: 3574–8.
33. Ferrannini, E, Buzzigoli G, Bonadonna R et al. Insulin resistance in essential hypertension. N Engl J Med 1987; 317: 350–7.
34. Reaven, GM, Lithell H, Landsberg L. Hypertension and associated metabolic abnormalities: the role of insulin resistance and the sympathoadrenal system. N Engl J Med 1996; 334: 374–81.
35. Montagnani M, Quon MJ. Insulin action in vascular endothelium: potential mechanisms linking insulin resistance with hypertension. Diabetes Obes Metab 2000; 2: 285–92.
36. Nystrom FH, Quon MJ. Insulin signalling: metabolic pathways and mechanisms for specificity. Cell Signal 1999; 11: 563–74.
37. Kashiwabara H, Inaba M, Maruno Y et al. Insulin levels during fasting and the glucose tolerance test and Homa's index predict subsequent development of hypertension. J Hypertens 2000; 18: 83–8.
38. Holman RR et al. UKPDS 80. N Eng J Med 2008; 359.
Авторы
Г.Б.Дорофеева*1, И.В.Дорофеев2
1 ГБОУ ВПО Северо-Западный государственный медицинский университет им. И.И.Мечникова Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
2 СПб ГБУЗ Городская больница №26. 196247, Россия, Санкт-Петербург, ул. Костюшко, д. 2
*DorofeevаGB@yandex.ru
________________________________________________
G.B.Dorofeeva*1, I.V.Dorofeev2
1 I.I.Mechnikov State Northwestern Medical University of the Ministry of Health of the Russian Federation. 191015, Russian Federation, Saint Petersburg, ul. Kirochnaia, d. 41
2 Clinical Hospital №26. 196247, Russian Federation, Saint Petersburg, ul. Kostiushko, d. 2
*DorofeevаGB@yandex.ru