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Сахарный диабет и сердечно-сосудистые заболевания. Актуальный подход к модификации образа жизни и лечению пациентов с сахарным диабетом 2-го типа
Сахарный диабет и сердечно-сосудистые заболевания. Актуальный подход к модификации образа жизни и лечению пациентов с сахарным диабетом 2-го типа
Волкова Е.А., Малыгина О.Ф. Сахарный диабет и сердечно-сосудистые заболевания. Актуальный подход к модификации образа жизни и лечению пациентов с сахарным диабетом 2-го типа. Consilium Medicum. 2019; 21 (1): 74–80. DOI: 10.26442/20751753.2019.1.190273
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Аннотация
Обоснование. Очень актуальной представляется проблема выбора оптимальных схем сахароснижающей терапии в связи с ростом числа пациентов с сахарным диабетом (СД) 2-го типа и повышенной смертностью таких больных от сердечно-сосудистых заболеваний (ССЗ). Современные рекомендации, представленные в консенсусном отчете Американской диабетической ассоциацией (ADA) совместно с Европейской ассоциацией по изучению сахарного диабета (EASD) от 2018 г., отражают комплексные подходы к лечению взрослых пациентов с СД 2-го типа не только с целью улучшения гликемического контроля, но и с целью снижения ССЗ и смертности от них.
Материалы и методы. Для написания данного обзора были проанализированы как консенсусный отчет ADA/EASD от 2018 г., так и рекомендации отечественных алгоритмов по лечению СД, а также ряда зарубежных источников, включая документы, подготовленные Управлением по санитарному надзору за качеством пищевых продуктов и медикаментов США (FDA) за 2008 г. и Американской ассоциацией клинических эндокринологов (ААСЕ) за последний год.
Результаты. Для снижения риска ССЗ и смертности при СД 2-го типа необходим комплексный контроль факторов риска их развития, включая изменение образа жизни пациента и применение безопасных и эффективных лекарственных средств, которые будут способствовать достижению целей нормализации липидного обмена, артериального давления, тромбоцитарного звена. Модификации образа жизни уделяется пристальное внимание. Под ней подразумевается поддержка и повышение уровня грамотности пациентов, разработка и реализация индивидуально подобранной программы нутритивной терапии, увеличение физической активности пациентов. При СД 2-го типа большое значение придается также самоконтролю уровня гликемии крови, поскольку он позволяет обученному пациенту лучше контролировать течение своего заболевания. Благоприятный для пациентов прогноз возможен только при комплексном и индивидуальном подходе.
Заключение. Несмотря на новые эффективные и безопасные препараты, более 1/2 пациентов не достигают целевых уровней гликемии. Имеет значение терапевтическая инертность, которая носит многофакторный характер. Необходимы усилия для ее преодоления, как со стороны всей системы здравоохранения, так и со стороны врачей и пациентов. Актуальной является современная комбинированная сахароснижающая терапия, позволяющая воздействовать на разные патогенетические механизмы, нивелировать вариабельность гликемии с повышением приверженности лекарственной терапии. На всех этапах лечения СД 2-го типа необходимо помнить о многофакторном и индивидуальном подходе для достижения долгосрочных успехов.
Ключевые слова: сахарный диабет 2-го типа, образ жизни, обучение пациентов, структурированные учебные программы, немедикаментозные методы лечения, самоконтроль, глюкометры, сахароснижающие препараты, сердечно-сосудистые заболевания, хроническая почечная недостаточность, ожирение.
Материалы и методы. Для написания данного обзора были проанализированы как консенсусный отчет ADA/EASD от 2018 г., так и рекомендации отечественных алгоритмов по лечению СД, а также ряда зарубежных источников, включая документы, подготовленные Управлением по санитарному надзору за качеством пищевых продуктов и медикаментов США (FDA) за 2008 г. и Американской ассоциацией клинических эндокринологов (ААСЕ) за последний год.
Результаты. Для снижения риска ССЗ и смертности при СД 2-го типа необходим комплексный контроль факторов риска их развития, включая изменение образа жизни пациента и применение безопасных и эффективных лекарственных средств, которые будут способствовать достижению целей нормализации липидного обмена, артериального давления, тромбоцитарного звена. Модификации образа жизни уделяется пристальное внимание. Под ней подразумевается поддержка и повышение уровня грамотности пациентов, разработка и реализация индивидуально подобранной программы нутритивной терапии, увеличение физической активности пациентов. При СД 2-го типа большое значение придается также самоконтролю уровня гликемии крови, поскольку он позволяет обученному пациенту лучше контролировать течение своего заболевания. Благоприятный для пациентов прогноз возможен только при комплексном и индивидуальном подходе.
Заключение. Несмотря на новые эффективные и безопасные препараты, более 1/2 пациентов не достигают целевых уровней гликемии. Имеет значение терапевтическая инертность, которая носит многофакторный характер. Необходимы усилия для ее преодоления, как со стороны всей системы здравоохранения, так и со стороны врачей и пациентов. Актуальной является современная комбинированная сахароснижающая терапия, позволяющая воздействовать на разные патогенетические механизмы, нивелировать вариабельность гликемии с повышением приверженности лекарственной терапии. На всех этапах лечения СД 2-го типа необходимо помнить о многофакторном и индивидуальном подходе для достижения долгосрочных успехов.
Ключевые слова: сахарный диабет 2-го типа, образ жизни, обучение пациентов, структурированные учебные программы, немедикаментозные методы лечения, самоконтроль, глюкометры, сахароснижающие препараты, сердечно-сосудистые заболевания, хроническая почечная недостаточность, ожирение.
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Background. The issue of optimal antihyperglycemic therapy choice presents essential, taking into consideration the increase of number of patients with diabetes mellitus (DM) type 2 and excessive mortality of these patients from cardiovascular diseases (CVD). The updated recommendations presented in consensus report of American Diabetes Association (ADA) in cooperation with European Association for the Study of Diabetes (EASD) in 2018 reflect complex approach to treatment of adult patients with DM type 2 that aims not only to improve glycemic control, but also to decrease CVD incidence and mortality.
Materials and methods. In order to write this review we analyzed ADA/EASD consensus report of 2018 as well as Russian algorithms and recommendations on DM treatment and several foreign sources including 2008 documents from US Food and Drug Administration (FDA) and the documents from American Association of Clinical Endocrinologists (AACE) published over the past year.
Results. A complex control of risk factors that includes patient’s lifestyle change and use of safe and effective medications that will contribute to lipid metabolism, arterial blood pressure and thrombocyte function normalization is required in order to reduce CVD risk and mortality in patients with DM type 2. Lifestyle modification is placed special focus on. It comprises patients’ encouragement and competence increase as well as development and implementation of an individualized program of nutrition intervention and patients’ physical activity increase. In patients with DM type 2 glycemia self-control is considered to be of great importance because it allows the trained patients to control the disease course much better. A favorable prognosis is possible only when complex individual approach is used.
Conclusion. Despite development of new effective and safe medications, more than ½ of the patients do not reach glycemia target levels. Therapeutic inactivity, that is multifactorial, is of great significance. In order to cope with it efforts are required both from the whole health care system and from medical practitioners and patients themselves. Modern combined antihyperglycemic therapy that has effect on various pathogenic mechanisms and allows to level down glycemia variability and increase treatment compliance is quite actual. During all stages of DM type 2 treatment it is essential to bear in mind that multifactor and individualized approach is required in order to achieve long-term results.
Key words: diabetes mellitus type 2, lifestyle, patients’ education, structured education programs, non-pharmacological treatment methods, self-control, glucometers, antihyperglycemic agents, cardiovascular disease, chronic kidney disease, obesity.
Materials and methods. In order to write this review we analyzed ADA/EASD consensus report of 2018 as well as Russian algorithms and recommendations on DM treatment and several foreign sources including 2008 documents from US Food and Drug Administration (FDA) and the documents from American Association of Clinical Endocrinologists (AACE) published over the past year.
Results. A complex control of risk factors that includes patient’s lifestyle change and use of safe and effective medications that will contribute to lipid metabolism, arterial blood pressure and thrombocyte function normalization is required in order to reduce CVD risk and mortality in patients with DM type 2. Lifestyle modification is placed special focus on. It comprises patients’ encouragement and competence increase as well as development and implementation of an individualized program of nutrition intervention and patients’ physical activity increase. In patients with DM type 2 glycemia self-control is considered to be of great importance because it allows the trained patients to control the disease course much better. A favorable prognosis is possible only when complex individual approach is used.
Conclusion. Despite development of new effective and safe medications, more than ½ of the patients do not reach glycemia target levels. Therapeutic inactivity, that is multifactorial, is of great significance. In order to cope with it efforts are required both from the whole health care system and from medical practitioners and patients themselves. Modern combined antihyperglycemic therapy that has effect on various pathogenic mechanisms and allows to level down glycemia variability and increase treatment compliance is quite actual. During all stages of DM type 2 treatment it is essential to bear in mind that multifactor and individualized approach is required in order to achieve long-term results.
Key words: diabetes mellitus type 2, lifestyle, patients’ education, structured education programs, non-pharmacological treatment methods, self-control, glucometers, antihyperglycemic agents, cardiovascular disease, chronic kidney disease, obesity.
Полный текст
Список литературы
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11. Волкова Е.А., Ворохобина Н.В., Малыгина О.Ф. Модификация образа жизни, обучение и самоконтроль – важные компоненты лечения сахарного диабета и улучшения качества жизни пациентов. Consilium Medicum. 2015 ; 17 (1): 54–62.
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[Dedov I.I., Shestakova M.V., Maiorov A.Iu. et al. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Sakharnyi diabet. 2017; 20 (1S): 1–121 (in Russian).]
14. American Diabetes Association. 4. Lifestyle management: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S38–S50.
15. Powers MA, Bardsley J, Cypress M et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 2015; 38: 1372–82.
16. Pillay J, Armstrong MJ, Butalia S et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Intern Med 2015; 163: 848–60.
17. He X, Li J, Wang B et al. Diabetes selfmanagement education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017; 55: 712–31.
18. Chatterjee S, Davies MJ, Heller S et al. Diabetes structured selfmanagement education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol 2018; 6: 130–42.
19. Anjana RM, Kesavadev J, Neeta D et al. A multicenter real-life study on the effect of flash glucose monitoring on glycemic control in patients with type 1 and type 2 diabetes. Diabetes Technol Ther 2017; 19: 533–40.
20. Riddle MC, Gerstein HC, Holman RR et al. A1C targets should be personalized to maximize benefits while limiting risks. Diabetes Care 2018; 41: 1121–4.
21. American Diabetes Association. 6. Glycemic targets: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S55–S64.
22. 2018 AACE/ACE T2D Management, Endocr Pract 2018; 24 (1): S91–S120.
23. Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016; 10: 1299–307.
24. McGovern A, Tippu Z, Hinton W et al. Comparison of medication adherence and persistence in type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 2018; 20: 1040–3.
25. American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment. Diabetes Care 2017; 40 (Suppl. 1): 64–74. DOI: 10.2337/dc17-S011
26. Marso SP, McGuire DK, Zinman B et al.; DEVOTE Study Group. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med 2017; 377: 723–32.
27. Rosenstock J, Hollander P, Bhargava A et al. Similar efficacy and safety of LY2963016 insulin glargine and insulin glargine (Lantus®) in patients with type 2 diabetes who were insulin-naive or previously treated with insulin glargine: a randomized, double-blind controlled trial (the ELEMENT 2 study). Diabetes Obes Metab 2015; 17: 734–41.
28. Schauer PR, Bhatt DL, Kirwan JP et al.; STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med 2017; 376: 641–51.
29. Mingrone G, Panunzi S, De Gaetano A et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386: 964–73.
30. Mechanick JI, Kushner RF, Sugerman HJ et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and non-surgical support of the bariatric surgery patient. Obesity (SilverSpring) 2009; 17 (Suppl. 1): S1–S70.
2. Vikulova O.K. Gosudarstvennyi registr sakharnogo diabeta RF: status 2015 i dannye issledovanii s aktivnym skriningom modulia "Diabet-tsentr", 3 marta 2016. gos.registr@endocrincentr.ru (in Russian).
3. Emerging Risk Factors Collaboration; Di Angelantonio E, Gao P et al. Glycated hemoglobin measurement and prediction of cardiovascular disease. JAMA 2014; 311 (12): 1225–33. DOI: 10.1001/jama.2014.1873
4. Shestakova E.A. Vybor vtoroi linii terapii u patsientov s sakharnym diabetom 2 tipa: aktivatsiia metabolicheskoi pamiati. Sakharnyi diabet. 2017; 20 (5): 356–62. DOI: 10.14341/DM8793 (in Russian).
5. U.S. Food and Drug Administration. Guidance for industry: diabetes mellitus – evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes [Internet]. Available from www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071627.pdf.
6. Konsensusnyi otchet ADA/EASD po lecheniiu giperglikemii pri sakharnom diabete tipa 2 po sostoianiiu na 2018 god. https://doi.org/10.2337/dci18-0033 (in Russian).
7. Lean ME, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018; 391: 541–51.
8. Boule NG, Haddad E, Kenny GP et al. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286: 1218–27.
9. Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 2011; 34: 1228–37.
10. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and metaanalysis of randomized clinical trials. J Acad Nutr Diet 2015; 115: 1447–63.
11. Volkova E.A., Vorokhobina N.V., Malygina O.F. Lifestyle modification, training and self-control as important components of diabetes treatment and improvement of patients life quality. Consilium Medicum. 2015; 17 (1): 54–62 (in Russian).
12. Volkova E.A., Malygina O.F. Self-control and lifestyle changes of patients as an important part of complex sugar therapy type 2 diabetes. Handbook for Practitioners Doctors. 2018; 2: 47–52 (in Russian).
13. Dedov I.I., Shestakova M.V., Maiorov A.Iu. et al. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Sakharnyi diabet. 2017; 20 (1S): 1–121 (in Russian).
14. American Diabetes Association. 4. Lifestyle management: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S38–S50.
15. Powers MA, Bardsley J, Cypress M et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 2015; 38: 1372–82.
16. Pillay J, Armstrong MJ, Butalia S et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Intern Med 2015; 163: 848–60.
17. He X, Li J, Wang B et al. Diabetes selfmanagement education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017; 55: 712–31.
18. Chatterjee S, Davies MJ, Heller S et al. Diabetes structured selfmanagement education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol 2018; 6: 130–42.
19. Anjana RM, Kesavadev J, Neeta D et al. A multicenter real-life study on the effect of flash glucose monitoring on glycemic control in patients with type 1 and type 2 diabetes. Diabetes Technol Ther 2017; 19: 533–40.
20. Riddle MC, Gerstein HC, Holman RR et al. A1C targets should be personalized to maximize benefits while limiting risks. Diabetes Care 2018; 41: 1121–4.
21. American Diabetes Association. 6. Glycemic targets: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S55–S64.
22. 2018 AACE/ACE T2D Management, Endocr Pract 2018; 24 (1): S91–S120.
23. Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016; 10: 1299–307.
24. McGovern A, Tippu Z, Hinton W et al. Comparison of medication adherence and persistence in type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 2018; 20: 1040–3.
25. American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment. Diabetes Care 2017; 40 (Suppl. 1): 64–74. DOI: 10.2337/dc17-S011
26. Marso SP, McGuire DK, Zinman B et al.; DEVOTE Study Group. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med 2017; 377: 723–32.
27. Rosenstock J, Hollander P, Bhargava A et al. Similar efficacy and safety of LY2963016 insulin glargine and insulin glargine (Lantus®) in patients with type 2 diabetes who were insulin-naive or previously treated with insulin glargine: a randomized, double-blind controlled trial (the ELEMENT 2 study). Diabetes Obes Metab 2015; 17: 734–41.
28. Schauer PR, Bhatt DL, Kirwan JP et al.; STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med 2017; 376: 641–51.
29. Mingrone G, Panunzi S, De Gaetano A et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386: 964–73.
30. Mechanick JI, Kushner RF, Sugerman HJ et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and non-surgical support of the bariatric surgery patient. Obesity (SilverSpring) 2009; 17 (Suppl. 1): S1–S70.
[Ametov A.S., Kurochkin I.O., Zubkov A.A. Sakharnyi diabet i serdechno-sosudistye zabolevaniia. RMZh. 2014; 13: 954. https://www.rmj.ru/articles/mnenie_eksperta/sakharnyy-diabet-i-serdechno-sosudistye-zabolevaniya/#ix... (in Russian).]
2. Викулова О.К. Государственный регистр сахарного диабета РФ: статус 2015 и данные исследований с активным скринингом модуля «Диабет-центр», 3 марта 2016. gos.registr@endocrincentr.ru
[Vikulova O.K. Gosudarstvennyi registr sakharnogo diabeta RF: status 2015 i dannye issledovanii s aktivnym skriningom modulia "Diabet-tsentr", 3 marta 2016. gos.registr@endocrincentr.ru (in Russian).]
3. Emerging Risk Factors Collaboration; Di Angelantonio E, Gao P et al. Glycated hemoglobin measurement and prediction of cardiovascular disease. JAMA 2014; 311 (12): 1225–33. DOI: 10.1001/jama.2014.1873
4. Шестакова Е.А. Выбор второй линии терапии у пациентов с сахарным диабетом 2 типа: активация метаболической памяти. Сахарный диабет. 2017; 20 (5): 356–62. DOI: 10.14341/DM8793
[Shestakova E.A. Vybor vtoroi linii terapii u patsientov s sakharnym diabetom 2 tipa: aktivatsiia metabolicheskoi pamiati. Sakharnyi diabet. 2017; 20 (5): 356–62. DOI: 10.14341/DM8793 (in Russian).]
5. U.S. Food and Drug Administration. Guidance for industry: diabetes mellitus – evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes [Internet]. Available from www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071627.pdf.
6. Консенсусный отчет ADA/EASD по лечению гипергликемии при сахарном диабете типа 2 по состоянию на 2018 год. https://doi.org/10.2337/dci18-0033
[Konsensusnyi otchet ADA/EASD po lecheniiu giperglikemii pri sakharnom diabete tipa 2 po sostoianiiu na 2018 god. https://doi.org/10.2337/dci18-0033 (in Russian).]
7. Lean ME, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018; 391: 541–51.
8. Boule NG, Haddad E, Kenny GP et al. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286: 1218–27.
9. Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 2011; 34: 1228–37.
10. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and metaanalysis of randomized clinical trials. J Acad Nutr Diet 2015; 115: 1447–63.
11. Волкова Е.А., Ворохобина Н.В., Малыгина О.Ф. Модификация образа жизни, обучение и самоконтроль – важные компоненты лечения сахарного диабета и улучшения качества жизни пациентов. Consilium Medicum. 2015 ; 17 (1): 54–62.
[Volkova E.A., Vorokhobina N.V., Malygina O.F. Lifestyle modification, training and self-control as important components of diabetes treatment and improvement of patients life quality. Consilium Medicum. 2015; 17 (1): 54–62 (in Russian).]
12. Волкова Е.А., Малыгина О.Ф. Самоконтроль и изменение образа жизни пациентов как важнейшая часть комплексной терапии сахарного диабета типа 2. Справочник поликлинического врача. 2018; 2: 47–52.
[Volkova E.A., Malygina O.F. Self-control and lifestyle changes of patients as an important part of complex sugar therapy type 2 diabetes. Handbook for Practitioners Doctors. 2018; 2: 47–52 (in Russian).]
13. Дедов И.И., Шестакова М.В., Майоров А.Ю. и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Сахарный диабет. 2017; 20 (1S): 1–121.
[Dedov I.I., Shestakova M.V., Maiorov A.Iu. et al. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Sakharnyi diabet. 2017; 20 (1S): 1–121 (in Russian).]
14. American Diabetes Association. 4. Lifestyle management: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S38–S50.
15. Powers MA, Bardsley J, Cypress M et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 2015; 38: 1372–82.
16. Pillay J, Armstrong MJ, Butalia S et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Intern Med 2015; 163: 848–60.
17. He X, Li J, Wang B et al. Diabetes selfmanagement education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017; 55: 712–31.
18. Chatterjee S, Davies MJ, Heller S et al. Diabetes structured selfmanagement education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol 2018; 6: 130–42.
19. Anjana RM, Kesavadev J, Neeta D et al. A multicenter real-life study on the effect of flash glucose monitoring on glycemic control in patients with type 1 and type 2 diabetes. Diabetes Technol Ther 2017; 19: 533–40.
20. Riddle MC, Gerstein HC, Holman RR et al. A1C targets should be personalized to maximize benefits while limiting risks. Diabetes Care 2018; 41: 1121–4.
21. American Diabetes Association. 6. Glycemic targets: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S55–S64.
22. 2018 AACE/ACE T2D Management, Endocr Pract 2018; 24 (1): S91–S120.
23. Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016; 10: 1299–307.
24. McGovern A, Tippu Z, Hinton W et al. Comparison of medication adherence and persistence in type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 2018; 20: 1040–3.
25. American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment. Diabetes Care 2017; 40 (Suppl. 1): 64–74. DOI: 10.2337/dc17-S011
26. Marso SP, McGuire DK, Zinman B et al.; DEVOTE Study Group. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med 2017; 377: 723–32.
27. Rosenstock J, Hollander P, Bhargava A et al. Similar efficacy and safety of LY2963016 insulin glargine and insulin glargine (Lantus®) in patients with type 2 diabetes who were insulin-naive or previously treated with insulin glargine: a randomized, double-blind controlled trial (the ELEMENT 2 study). Diabetes Obes Metab 2015; 17: 734–41.
28. Schauer PR, Bhatt DL, Kirwan JP et al.; STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med 2017; 376: 641–51.
29. Mingrone G, Panunzi S, De Gaetano A et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386: 964–73.
30. Mechanick JI, Kushner RF, Sugerman HJ et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and non-surgical support of the bariatric surgery patient. Obesity (SilverSpring) 2009; 17 (Suppl. 1): S1–S70.
________________________________________________
2. Vikulova O.K. Gosudarstvennyi registr sakharnogo diabeta RF: status 2015 i dannye issledovanii s aktivnym skriningom modulia "Diabet-tsentr", 3 marta 2016. gos.registr@endocrincentr.ru (in Russian).
3. Emerging Risk Factors Collaboration; Di Angelantonio E, Gao P et al. Glycated hemoglobin measurement and prediction of cardiovascular disease. JAMA 2014; 311 (12): 1225–33. DOI: 10.1001/jama.2014.1873
4. Shestakova E.A. Vybor vtoroi linii terapii u patsientov s sakharnym diabetom 2 tipa: aktivatsiia metabolicheskoi pamiati. Sakharnyi diabet. 2017; 20 (5): 356–62. DOI: 10.14341/DM8793 (in Russian).
5. U.S. Food and Drug Administration. Guidance for industry: diabetes mellitus – evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes [Internet]. Available from www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/ucm071627.pdf.
6. Konsensusnyi otchet ADA/EASD po lecheniiu giperglikemii pri sakharnom diabete tipa 2 po sostoianiiu na 2018 god. https://doi.org/10.2337/dci18-0033 (in Russian).
7. Lean ME, Leslie WS, Barnes AC et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018; 391: 541–51.
8. Boule NG, Haddad E, Kenny GP et al. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286: 1218–27.
9. Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care 2011; 34: 1228–37.
10. Franz MJ, Boucher JL, Rutten-Ramos S, VanWormer JJ. Lifestyle weight-loss intervention outcomes in overweight and obese adults with type 2 diabetes: a systematic review and metaanalysis of randomized clinical trials. J Acad Nutr Diet 2015; 115: 1447–63.
11. Volkova E.A., Vorokhobina N.V., Malygina O.F. Lifestyle modification, training and self-control as important components of diabetes treatment and improvement of patients life quality. Consilium Medicum. 2015; 17 (1): 54–62 (in Russian).
12. Volkova E.A., Malygina O.F. Self-control and lifestyle changes of patients as an important part of complex sugar therapy type 2 diabetes. Handbook for Practitioners Doctors. 2018; 2: 47–52 (in Russian).
13. Dedov I.I., Shestakova M.V., Maiorov A.Iu. et al. Algoritmy spetsializirovannoi meditsinskoi pomoshchi bol'nym sakharnym diabetom. Sakharnyi diabet. 2017; 20 (1S): 1–121 (in Russian).
14. American Diabetes Association. 4. Lifestyle management: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S38–S50.
15. Powers MA, Bardsley J, Cypress M et al. Diabetes self-management education and support in type 2 diabetes: a joint position statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Diabetes Care 2015; 38: 1372–82.
16. Pillay J, Armstrong MJ, Butalia S et al. Behavioral programs for type 2 diabetes mellitus: a systematic review and network meta-analysis. Ann Intern Med 2015; 163: 848–60.
17. He X, Li J, Wang B et al. Diabetes selfmanagement education reduces risk of all-cause mortality in type 2 diabetes patients: a systematic review and meta-analysis. Endocrine 2017; 55: 712–31.
18. Chatterjee S, Davies MJ, Heller S et al. Diabetes structured selfmanagement education programmes: a narrative review and current innovations. Lancet Diabetes Endocrinol 2018; 6: 130–42.
19. Anjana RM, Kesavadev J, Neeta D et al. A multicenter real-life study on the effect of flash glucose monitoring on glycemic control in patients with type 1 and type 2 diabetes. Diabetes Technol Ther 2017; 19: 533–40.
20. Riddle MC, Gerstein HC, Holman RR et al. A1C targets should be personalized to maximize benefits while limiting risks. Diabetes Care 2018; 41: 1121–4.
21. American Diabetes Association. 6. Glycemic targets: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S55–S64.
22. 2018 AACE/ACE T2D Management, Endocr Pract 2018; 24 (1): S91–S120.
23. Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence 2016; 10: 1299–307.
24. McGovern A, Tippu Z, Hinton W et al. Comparison of medication adherence and persistence in type 2 diabetes: a systematic review and meta-analysis. Diabetes Obes Metab 2018; 20: 1040–3.
25. American Diabetes Association. Pharmacologic Approaches to Glycemic Treatment. Diabetes Care 2017; 40 (Suppl. 1): 64–74. DOI: 10.2337/dc17-S011
26. Marso SP, McGuire DK, Zinman B et al.; DEVOTE Study Group. Efficacy and safety of degludec versus glargine in type 2 diabetes. N Engl J Med 2017; 377: 723–32.
27. Rosenstock J, Hollander P, Bhargava A et al. Similar efficacy and safety of LY2963016 insulin glargine and insulin glargine (Lantus®) in patients with type 2 diabetes who were insulin-naive or previously treated with insulin glargine: a randomized, double-blind controlled trial (the ELEMENT 2 study). Diabetes Obes Metab 2015; 17: 734–41.
28. Schauer PR, Bhatt DL, Kirwan JP et al.; STAMPEDE Investigators. Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. N Engl J Med 2017; 376: 641–51.
29. Mingrone G, Panunzi S, De Gaetano A et al. Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. Lancet 2015; 386: 964–73.
30. Mechanick JI, Kushner RF, Sugerman HJ et al. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and non-surgical support of the bariatric surgery patient. Obesity (SilverSpring) 2009; 17 (Suppl. 1): S1–S70.
Авторы
Е.А.Волкова*, О.Ф.Малыгина
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
*doctorelena555@gmail.com
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И.Мечникова» Минздрава России. 191015, Россия, Санкт-Петербург, ул. Кирочная, д. 41
*doctorelena555@gmail.com
________________________________________________
Elena A. Volkova*, Olga F. Malygina
I.I.Mechnikov North-West State Medical University of the Ministry of Health of the Russian Federation. 41, Kirochnaia st., Saint Petersburg, 191015, Russian Federation
*doctorelena555@gmail.com
I.I.Mechnikov North-West State Medical University of the Ministry of Health of the Russian Federation. 41, Kirochnaia st., Saint Petersburg, 191015, Russian Federation
*doctorelena555@gmail.com
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