Важность контроля гликемии у больных с ранними формами нарушения углеводного обмена в целях профилактики сахарного диабета 2-го типа и сердечно-сосудистой патологии
Важность контроля гликемии у больных с ранними формами нарушения углеводного обмена в целях профилактики сахарного диабета 2-го типа и сердечно-сосудистой патологии
Кочергина И.И. Важность контроля гликемии у больных с ранними формами нарушения углеводного обмена в целях профилактики сахарного диабета 2-го типа и сердечно-сосудистой патологии. Consilium Medicum. 2020; 22 (12): 57–62. DOI: 10.26442/20751753.2020.12.200191
________________________________________________
Kochergina I.I. The importance of glycemic control in patients with early forms of carbohydrate metabolism disorders in order to prevent type 2 diabetes mellitus and cardiovascular pathology. Consilium Medicum. 2020; 22 (12): 57–62. DOI: 10.26442/20751753.2020.12.200191
Важность контроля гликемии у больных с ранними формами нарушения углеводного обмена в целях профилактики сахарного диабета 2-го типа и сердечно-сосудистой патологии
Кочергина И.И. Важность контроля гликемии у больных с ранними формами нарушения углеводного обмена в целях профилактики сахарного диабета 2-го типа и сердечно-сосудистой патологии. Consilium Medicum. 2020; 22 (12): 57–62. DOI: 10.26442/20751753.2020.12.200191
________________________________________________
Kochergina I.I. The importance of glycemic control in patients with early forms of carbohydrate metabolism disorders in order to prevent type 2 diabetes mellitus and cardiovascular pathology. Consilium Medicum. 2020; 22 (12): 57–62. DOI: 10.26442/20751753.2020.12.200191
В статье представлены данные о распространенности сахарного диабета (СД) и предиабета; о высокой сочетаемости СД и кардиоваскулярной патологии; о высокой смертности среди больных СД и ишемической болезнью сердца при наличии как острых, так и хронических кардиоваскулярных осложнений; о важной роли глюкозо- и липотоксичности в прогрессировании нарушений углеводного обмена от стадии предиабета до СД 2-го типа, о роли гипергликемии в развитии инсулинорезистентности, атеросклероза, гипертензии, патологии печени, почек, эндотелиальной дисфункции, о роли гипер- и гипогликемий в развитии острых сосудистых осложнений – инфаркта миокарда, инсульта, гангрены нижних конечностей; о защитной роли адипонектина – предиктора СД 2-го типа, о важности контроля гликемии для своевременного выявления ранних нарушений углеводного обмена – нарушения толерантности к глюкозе и нарушения гликемии натощак; о роли метформина в профилактике прогрессирования предиабета до СД 2-го типа и кардиальной патологии, о глюко- и кардиопротективной роли современных сахароснижающих препаратов.
Ключевые слова: сахарный диабет, нарушение толерантности к глюкозе, нпрушение гликемии натощак, контроль гликемии, сердечно-сосудистые осложнения.
________________________________________________
The article presents data on the prevalence of diabetes and prediabetes; the high compatibility of diabetes mellitus and cardiovascular pathology; high mortality among patients with diabetes mellitus and coronary heart disease, in the presence of both acute and chronic cardiovascular complications; on the important role of glucose- and lipotoxicity in the progression of carbohydrate metabolism from prediabetes to type 2 diabetes mellitus, the role of hyperglycemia in the development of insulin resistance, atherosclerosis, hypertension, liver, kidney, endothelial dysfunction, the role of hyper- and hypoglycemia in the development of acute vascular complications – myocardial infarction, stroke, gangrene of the lower extremities; on the protective role of adiponectin – a predictor of type 2 diabetes mellitus, on the importance of glycemic control for the timely detection of early disorders of carbohydrate metabolism – impaired glucose tolerance and impaired fasting glucose; on the role of metformin in the prevention of progression of prediabetes to type 2 diabetes and cardiac pathology; on the gluco- and cardioprotective role of modern sugar-lowering drugs.
1. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. 9-й вып. (доп.). М., 2019.
[Algorithms for specialized medical care for patients with diabetes. Pod red. I.I. Dedova, M.V. Shestakovoi, A.Iu. Maiorova. 9-i vyp. (dop.). Moscow, 2019 (in Russian).]
2. Диабетом можно управлять: вызов привычному образу жизни как надежда наших пациентов. Интервью с А.С. Аметовым. Consilium Medicum. 2017; 19 (10): 118–22. DOI: 10.26442/2075-1753_19.10.118-122
[Diabetes can be operated: challenge the habitual way of life as the hope of our patients. Interview with A.S. Ametov. Consilium Medicum. 2017; 19 (10): 118–122. DOI: 10.26442/2075-1753_19.10.118-122 (in Russian).]
3. ВОЗ. Сердечно-сосудистые заболевания. WHO. www.who.int. 2019.
[VOZ. Serdechno-sosudistye zabolevaniia. WHO. www.who.int. 2019 (in Russian).]
4. Статистический сборник, 2017 г. www.rosminzdrav.ru
[Statisticheskii sbornik, 2017 g. www.rosminzdrav.ru (in Russian).]
5. IDF Diabetes Atlas. 6-th ed. 2013.
6. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S13-S27. DOI: 10.10.2337/dc18-S002
7. 2017 IDF clinical practice recommendations for managing type 2 diabetes in primary care. https://www.idf.org/e-library/guidelines/128-idf
8. Ekoe JM, Goldenberg R, Katz P. Diabetes Canada Clinical Practice Guidelines Expert Committee, Screening for Diabetes in Adults. Can J Diabetes 2018; 42 (Suppl. 1): S16–S19. DOI: 10.1016/j.jcjd.2017.10.00427
9. NICE 2017 Type 2 diabetes: prevention in people at high risk. nice.org.uk/guidance/ph38.
10. Предиабет как междисциплинарная проблема: определение, риски, подходы к диагностике и профилактике сахарного диабета 2 типа и сердечно-сосудистых осложнений. Совет экспертов: Барбараш О.Л., Воевода М.И., Галстян Г.Р., Шестакова М.В. и др. Рос. кардиол. журн. 2019; 24 (4): 83–91. DOI: 10.15829/1560-4071-2019-4-83-91
[Prediabet kak mezhdistsiplinarnaia problema: opredelenie, riski, podkhody k diagnostike i profilaktike sakharnogo diabeta 2 tipa i serdechno-sosudistykh oslozhnenii. Sovet ekspertov: Barbarash O.L., Voevoda M.I., Galstian G.R., Shestakova M.V. et al. Ros. kardiol. zhurn. 2019; 24 (4): 83–91. DOI: 10.15829/1560-4071-2019-4-83-91 (in Russian).]
11. The DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86.
12. 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.
13. Структура сердечнo-сосудистой заболеваемости и смертности в РФ за 2004 г. Клин. медицина 2005; 1: 3–8.
[Struktura serdechno-sosudistoi zabolevaemosti i smertnosti v RF za 2004 g. Klin. meditsina 2005; 1: 3–8 (in Russian).]
14. Haffner SM, Lehto S, Ronnemaa T. Mortality from coronary artery disease in subject with type 2 diabetes and nondiabetic subjects with and without myocardial infarction. N Engl J Med 1998; 339: 229–34.
15. Manson JE, Colditz GA, Stampfer MJ et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med 1991; 151: 1141–7.
16. Eringa EC, Serne EH, Meijer RI et al. Endothelial dysfunction in (pre)diabetes: Characteristics, causative mechanisms and pathogenic role in type 2 diabetes. Rev Endocr Metab Disord 2013; 14 (1): 39–48. DOI: 10.1007/s11154-013-9239-7.
17. Caballero AE, Arora S, Saouaf R et al. Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 di abetes. Diabetes 1999; 48 (9): 1856–62.
18. Сумин А.Н., Безденежных Н.А., Безденежных А.В. и др. Предоперационный статус и госпитальные осложнения коронарного шунтирования у пациентов с предиабетом и сахарным диабетом 2 типа. Рос. кардиол. журн. 2018; 5: 40–8. DOI: 10.15829/1560-4071-2018-5-40-48
[Sumin A.N., Bezdenezhnykh N.A., Bezdenezhnykh A.V. et al. Predoperatsionnyi status i gospital'nye oslozhneniia koronarnogo shuntirovaniia u patsientov s prediabetom i sakharnym diabetom 2 tipa. Ros. kardiol. zhurn. 2018; 5: 40–8. DOI: 10.15829/1560-4071-2018-5-40-48 (in Russian).]
19. Neaton JD, Wentworth DN, Cutler J, Kuller L. Risk factors for death from different types of stroke. Multiple Risk Factor Intervention trial Research Group. Ann Epidemiol 1993; 3: 493–99.
20. Kannel WB, Mc Gree DL. Diabetes and cardiovascular disease: the Frammingam study. JAMA 1979; 241: 2035–8.
21. Ощепкова Е.В. Смертность населения от сердечно-сосудистых заболеваний в Российской Федерации и пути по ее снижению. Кардиология. 2009; 2: 267–72.
[Oshchepkova E.V. Smertnost' naseleniia ot serdechno-sosudistykh zabolevanii v Rossiiskoi Federatsii i puti po ee snizheniiu. Kardiologiia. 2009; 2: 267–72 (in Russian).]
22. Бетуганова Л.В., Эльгаров А.А., Байсултанова М.Г. и др. Инфаркт миокарда: частота, половозрастные, профессиональные и клинические особенности. Кардиосоматика. 2014; 2: 10–4.
[Betuganova L.V., Elgarov A.A., Baysultanova M.B. et al. Myocardial infarction: frequency, professional, clinical and sex-related peculiarities, medical rehabilitation. Cardiosomatics. 2014; 2: 10–4 (in Russian).]
23. Аметов А.С. Сахарный диабет 2 типа. Проблемы и решения. Учебное пособие. 2-е изд, перераб. и доп. М.: ГЭОТАР-Медиа, 2014.
[Ametov A.S. Type 2 diabetes. Problems and solutions. Tutorial. 2-e izd, pererab. i dop. Moscow: GEOTAR-Media, 2014 (in Russian).]
24. The Task Force on Diabetes and Cardiovascular Disease of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Guidelines on diabetes, pre-diabetes, and cardiovascular disease: executive summary. Eur Heart J 2007; 28: 464–6.
25. Аметов А.С., Черникова Н.А., Пьяных О.П., Ермакова Е.А. Роль и место глюкокардиомониторирования в оценке кардиологических рисков у пациентов с сахарным диабетом 2 типа. В кн.: Аметов А.С. Сахарный диабет 2 типа. Проблемы и решения. Уч. пособие. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2014; c. 821–91.
[Ametov A.S., Chernikova N.A., P'ianykh O.P., Ermakova E.A. The role and place of glucocardiomonitoring in assessing cardiological risks in patients with type 2 diabetes. In the book: Ametov A.S. Type 2 diabetes. Problems and solutions. Tutorial. 2-e izd., pererab. i dop. Moscow: GEOTAR-Media, 2014; s. 821–51 (in Russian).]
26. ACCORD Study Group. N Engl J Med 2008; 358: 2545–59.
27. ADVANCE Colladorative Group Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Engl J Med 2008; 358: 2560–72.
28. Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type 2 diabetes. Engl J Med 2009; 360: 129–39.
29. Инструкция по применению лекарственного препарата для медицинского применения Глюкофаж® П N014600/01.
[Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Gliukofazh® P N014600/01 (in Russian).]
30. Goldberg RB, Aroda VR, Bluemke DA et al. Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium. Circulation 2017; 136 (1): 52–64. DOI: 10.1161/CIRCULATIONAHA.116.025483.
31. Goldberg RB, Temprosa MG, Mather KJ et al. Lifestyle and metformin in terventions have a durable effect to lower CRP and tPA levels in the Diabetes Preven tion Program except in those who develop diabetes. Diabetes Care 2014; 37 (8): 2253–60. DOI: 10.2337/dc13-2471.
32. Mohan M, Al-Talabany S, McKinnie A et al. Metformin regresses left ventricular hypertrophy in normotensive patients with coronary artery disease without type 2 dia betes mellitus – the met-remodel trial. Heart 2018; 104: A6. DOI: 10.1136/heartjnl-2018-BCS.6.
33. Vitale C, Mercuro G, Cornoldi A et al. Metformin improves endothelial function in patients with metabolic syndrome. J Intern Med 2005; 258 (3): 250–6. DOI: 10.1111/j.1365-2796.2005.01531.x.
34. Goldberg R, Temprosa M, Otvos J et al. Lifestyle and metformin treatment favorably influence lipoprotein subfraction distribution in the Diabetes Prevention Program. J Clin Endocrinol Metab 2013; 98 (10): 3989–98. DOI: 10.1210/jc.2013- 1452.
35. Zhou L, Liu H, Wen X et al. Effects of metformin on blood pressure in nondiabetic patients J Hypertens 2017; 35 (1): 18–26. DOI: 10.1097/HJH.0000000000001119
36. Анциферов М.Б., Котешкова О.М. Управление сахарным диабетом: организация и значение самоконтроля. Трудный пациент. 2009; 7 (10).
[Antsiferov M.B., Koteshkova O.M. Upravlenie sakharnym diabetom: organizatsiia i znachenie samokontrolia. Trudnyi patsient. 2009; 7 (10) (in Russian).]
37. Кочергина И.И. Самоконтроль гликемии у больных сахарным диабетом и кардиальной патологией с помощью глюкометра «Контур ТС». Кардиосоматика. 2014; 5 (3–4): 14–9.
[Kochergina I.I. Self-monitoring of blood glucose in patients with diabetes and cardiac pathology with the Meter Contour TS use. Cardiosomatics. 2014; 5 (3–4): 14–9 (in Russian).]
38. Dedov I, Shestakova M, Galstyan G et al. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Res Clin Pract 2016; 115: 90–5. DOI: 10.1016/j.diabres.2016.02.010.
39. Симонова Г. И., Мустафина С. В., Печенкина Е. А. Распространенность метаболического синдрома в Сибири: популяционное исследование в г. Новосибирске. Бюл. СО РАМН. 2011; 31 (5): 100–6.
[Simonova G. I., Mustafina S. V., Pechenkina E. A. Rasprostranennost' metabolicheskogo sindroma v Sibiri: populiatsionnoe issledovanie v g. Novosibirske. Biul. SO RAMN. 2011; 31 (5): 100–6 (in Russian).]
________________________________________________
1. Algorithms for specialized medical care for patients with diabetes. Pod red. I.I. Dedova, M.V. Shestakovoi, A.Iu. Maiorova. 9-i vyp. (dop.). Moscow, 2019 (in Russian).
2. Diabetes can be operated: challenge the habitual way of life as the hope of our patients. Interview with A.S. Ametov. Consilium Medicum. 2017; 19 (10): 118–122. DOI: 10.26442/2075-1753_19.10.118-122 (in Russian).
3. VOZ. Serdechno-sosudistye zabolevaniia. WHO. www.who.int. 2019 (in Russian).
4. Statisticheskii sbornik, 2017 g. www.rosminzdrav.ru (in Russian).
5. IDF Diabetes Atlas. 6-th ed. 2013.
6. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes – 2018. Diabetes Care 2018; 41 (Suppl. 1): S13-S27. DOI: 10.10.2337/dc18-S002
7. 2017 IDF clinical practice recommendations for managing type 2 diabetes in primary care. https://www.idf.org/e-library/guidelines/128-idf
8. Ekoe JM, Goldenberg R, Katz P. Diabetes Canada Clinical Practice Guidelines Expert Committee, Screening for Diabetes in Adults. Can J Diabetes 2018; 42 (Suppl. 1): S16–S19. DOI: 10.1016/j.jcjd.2017.10.00427
9. NICE 2017 Type 2 diabetes: prevention in people at high risk. nice.org.uk/guidance/ph38.
10. Prediabet kak mezhdistsiplinarnaia problema: opredelenie, riski, podkhody k diagnostike i profilaktike sakharnogo diabeta 2 tipa i serdechno-sosudistykh oslozhnenii. Sovet ekspertov: Barbarash O.L., Voevoda M.I., Galstian G.R., Shestakova M.V. et al. Ros. kardiol. zhurn. 2019; 24 (4): 83–91. DOI: 10.15829/1560-4071-2019-4-83-91 (in Russian).
11. The DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977–86.
12. 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.
13. Struktura serdechno-sosudistoi zabolevaemosti i smertnosti v RF za 2004 g. Klin. meditsina 2005; 1: 3–8 (in Russian).
14. Haffner SM, Lehto S, Ronnemaa T. Mortality from coronary artery disease in subject with type 2 diabetes and nondiabetic subjects with and without myocardial infarction. N Engl J Med 1998; 339: 229–34.
15. Manson JE, Colditz GA, Stampfer MJ et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch Intern Med 1991; 151: 1141–7.
16. Eringa EC, Serne EH, Meijer RI et al. Endothelial dysfunction in (pre)diabetes: Characteristics, causative mechanisms and pathogenic role in type 2 diabetes. Rev Endocr Metab Disord 2013; 14 (1): 39–48. DOI: 10.1007/s11154-013-9239-7.
17. Caballero AE, Arora S, Saouaf R et al. Microvascular and macrovascular reactivity is reduced in subjects at risk for type 2 di abetes. Diabetes 1999; 48 (9): 1856–62.
18. Sumin A.N., Bezdenezhnykh N.A., Bezdenezhnykh A.V. et al. Predoperatsionnyi status i gospital'nye oslozhneniia koronarnogo shuntirovaniia u patsientov s prediabetom i sakharnym diabetom 2 tipa. Ros. kardiol. zhurn. 2018; 5: 40–8. DOI: 10.15829/1560-4071-2018-5-40-48 (in Russian).
19. Neaton JD, Wentworth DN, Cutler J, Kuller L. Risk factors for death from different types of stroke. Multiple Risk Factor Intervention trial Research Group. Ann Epidemiol 1993; 3: 493–99.
20. Kannel WB, Mc Gree DL. Diabetes and cardiovascular disease: the Frammingam study. JAMA 1979; 241: 2035–8.
21. Oshchepkova E.V. Smertnost' naseleniia ot serdechno-sosudistykh zabolevanii v Rossiiskoi Federatsii i puti po ee snizheniiu. Kardiologiia. 2009; 2: 267–72 (in Russian).
22. Betuganova L.V., Elgarov A.A., Baysultanova M.B. et al. Myocardial infarction: frequency, professional, clinical and sex-related peculiarities, medical rehabilitation. Cardiosomatics. 2014; 2: 10–4 (in Russian).
23. Ametov A.S. Type 2 diabetes. Problems and solutions. Tutorial. 2-e izd, pererab. i dop. Moscow: GEOTAR-Media, 2014 (in Russian).
24. The Task Force on Diabetes and Cardiovascular Disease of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Guidelines on diabetes, pre-diabetes, and cardiovascular disease: executive summary. Eur Heart J 2007; 28: 464–6.
25. Ametov A.S., Chernikova N.A., P'ianykh O.P., Ermakova E.A. The role and place of glucocardiomonitoring in assessing cardiological risks in patients with type 2 diabetes. In the book: Ametov A.S. Type 2 diabetes. Problems and solutions. Tutorial. 2-e izd., pererab. i dop. Moscow: GEOTAR-Media, 2014; s. 821–51 (in Russian).
26. ACCORD Study Group. N Engl J Med 2008; 358: 2545–59.
27. ADVANCE Colladorative Group Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. Engl J Med 2008; 358: 2560–72.
28. Duckworth W, Abraira C, Moritz T et al. Glucose control and vascular complications in veterans with type 2 diabetes. Engl J Med 2009; 360: 129–39.
29. Instruktsiia po primeneniiu lekarstvennogo preparata dlia meditsinskogo primeneniia Gliukofazh® P N014600/01 (in Russian).
30. Goldberg RB, Aroda VR, Bluemke DA et al. Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium. Circulation 2017; 136 (1): 52–64. DOI: 10.1161/CIRCULATIONAHA.116.025483.
31. Goldberg RB, Temprosa MG, Mather KJ et al. Lifestyle and metformin in terventions have a durable effect to lower CRP and tPA levels in the Diabetes Preven tion Program except in those who develop diabetes. Diabetes Care 2014; 37 (8): 2253–60. DOI: 10.2337/dc13-2471.
32. Mohan M, Al-Talabany S, McKinnie A et al. Metformin regresses left ventricular hypertrophy in normotensive patients with coronary artery disease without type 2 dia betes mellitus – the met-remodel trial. Heart 2018; 104: A6. DOI: 10.1136/heartjnl-2018-BCS.6.
33. Vitale C, Mercuro G, Cornoldi A et al. Metformin improves endothelial function in patients with metabolic syndrome. J Intern Med 2005; 258 (3): 250–6. DOI: 10.1111/j.1365-2796.2005.01531.x.
34. Goldberg R, Temprosa M, Otvos J et al. Lifestyle and metformin treatment favorably influence lipoprotein subfraction distribution in the Diabetes Prevention Program. J Clin Endocrinol Metab 2013; 98 (10): 3989–98. DOI: 10.1210/jc.2013- 1452.
35. Zhou L, Liu H, Wen X et al. Effects of metformin on blood pressure in nondiabetic patients J Hypertens 2017; 35 (1): 18–26. DOI: 10.1097/HJH.0000000000001119
36. Antsiferov M.B., Koteshkova O.M. Upravlenie sakharnym diabetom: organizatsiia i znachenie samokontrolia. Trudnyi patsient. 2009; 7 (10) (in Russian).
37. Kochergina I.I. Self-monitoring of blood glucose in patients with diabetes and cardiac pathology with the Meter Contour TS use. Cardiosomatics. 2014; 5 (3–4): 14–9 (in Russian).
38. Dedov I, Shestakova M, Galstyan G et al. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes Res Clin Pract 2016; 115: 90–5. DOI: 10.1016/j.diabres.2016.02.010.
39. Simonova G. I., Mustafina S. V., Pechenkina E. A. Rasprostranennost' metabolicheskogo sindroma v Sibiri: populiatsionnoe issledovanie v g. Novosibirske. Biul. SO RAMN. 2011; 31 (5): 100–6 (in Russian).
Авторы
И.И. Кочергина
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия kii7@yandex.ru
________________________________________________
Irina I. Kochergina
Russian Medical Academy of Continuous Professional Education, Moscow, Russia kii7@yandex.ru