Диагностика и лечение предиабета как профилактика сахарного диабета 2-го типа

Петунина Н.А., Мартиросян Н.С., Хачатуров М.В., Жутаева М.А., Шапошникова А.А., Карпенко Е.В., Абдулганиева З.А. Диагностика и лечение предиабета как профилактика сахарного диабета 2-го типа. Consilium Medicum. 2023;25(4):229–235. DOI: 10.26442/20751753.2023.4.202312

© ООО «КОНСИЛИУМ МЕДИКУМ», 2023

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Petunina NA, Martirosian NS, Khachaturov MV, Zhutaeva MA, Shaposhnikova AA, Karpenko EV, Abdulganieva ZA. Diagnosis and treatment of prediabetes as prevention of type 2 diabetes: A review. Consilium Medicum. 2023;25(4):229–235. DOI: 10.26442/20751753.2023.4.202312

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Аннотация

Предиабет является нарушением углеводного обмена, при котором не достигаются критерии сахарного диабета, но превышены нормальные значения глюкозы крови; такая промежуточная гипергликемия ассоциирована с высоким риском развития диабета и сердечно-сосудистых заболеваний. Численность пациентов с сахарным диабетом продолжает неуклонно расти, в связи с чем очевидна необходимость своевременных вмешательств на этапе предиабета. Современный подход к профилактике прогрессирования предиабета включает коррекцию факторов риска сердечно-сосудистых заболеваний, артериальной гипертензии, дислипидемии, снижение массы тела и/или предотвращение ее увеличения, улучшение качества жизни. Терапией 1-й линии при предиабете является изменение образа жизни, которое включает в себя изменение питания, физической активности, коррекцию избыточной массы тела, отказ от вредных привычек, гигиену сна. Таким образом, нефармакологический подход к лечению пациентов, нацеленный на снижение избыточной массы тела, играет основную роль. В условиях недостаточной эффективности мероприятий по изменению образа жизни целесообразно назначение медикаментозной терапии. Препаратом 1-й линии для профилактики прогрессирования нарушений углеводного обмена является метформин. В дополнение к модификации образа жизни также продемонстрировали свою эффективность орлистат, препараты из группы аналогов глюкагоноподобного пептида-1, тиазолидиндионы, акарбоза. Бариатрическая хирургия ассоциируется с улучшением гликемического контроля у пациентов с предиабетом.

Ключевые слова: предиабет, сахарный диабет 2-го типа, профилактика диабета, модификация образа жизни

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Prediabetes is defined as a disorder in which the criteria for diabetes mellitus are not met, but normal blood glucose values are exceeded; this intermediate hyperglycemia is associated with a high risk of developing diabetes and cardiovascular disease. The number of patients with diabetes mellitus continues to grow steadily, and therefore the role of timely interventions at the stage of prediabetes is obvious. A modern approach to preventing the progression of prediabetes includes correcting risk factors for cardiovascular diseases, arterial hypertension, dyslipidemia, weight loss and/or prevention of weight gain, and improving the quality of life. The first-line therapy for prediabetes is lifestyle modification, which includes changes in diet, physical activity, weight management, bad habits, and sleep hygiene. Thus, a non-pharmacological approach to the treatment of patients, aimed at reducing excess weight, plays a major role. In conditions of insufficient effectiveness of measures to change lifestyle, it is advisable to prescribe drug therapy. Metformin is the first-line drug for preventing the progression of carbohydrate metabolism disorders. In addition to lifestyle modification, orlistat, drugs from the group of GLP-1 analogues, thiazolidinediones, and acarbose have also demonstrated their effectiveness. Bariatric surgery is associated with improved glycemic control in prediabetic patients.

Keywords: prediabetes, type 2 diabetes, diabetes prevention, lifestyle modification

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1. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. DOI:10.1016/j.diabres.2021.109119
2. Dedov II, Shestakova MV, Vikulova OK, et al. Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01.01.2021. Diabetes mellitus. 2021;24(3):204-21 (in Russian).
3. Dedov II, Shestakova MV, Mayorov AYu, et al. Standards of specialized diabetes care. Ed. by II Dedov, MV Shestakova, AYu Mayorov. 10th edition. Diabetes mellitus. 2021;24(1S):1-148 (in Russian). DOI:10.14341/DM12802
4. Perreault L, Bergman BC, Playdon MC, et al. Impaired fasting glucose with or without impaired glucose tolerance: progressive or parallel states of prediabetes? Am J Physiol Endocrinol Metab. 2008;295(2):E428-35. DOI:10.1152/ajpendo.90354.2008
5. Echouffo-Tcheugui JB, Perreault L, Ji L, Dagogo-Jack S. Diagnosis and Management of Prediabetes: A Review. JAMA. 2023;329(14):1206-16. DOI:10.1001/jama.2023.4063
6. Morgunova TB, Glinkina IV, Fadeev VV. Prediabetes: challenges and opportunities. Medical Council. 2021;(12):220-7 (in Russian). DOI:10.21518/2079-701X-2021-12-220-227
7. Shestakova EA, Lunina EY, Galstyan GR, et al. Type 2 diabetes and prediabetes prevalence in patients with different risk factor combinations in the NATION study. Diabetes mellitus. 2020;23(1):4-11 (in Russian). DOI:10.14341/DM12286
8. Zhang Y, Pan XF, Chen J, et al. Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. Diabetologia. 2020;63(1):21-33. DOI:10.1007/s00125-019-04985-9
9. Díaz-Redondo A, Giráldez-García C, Carrillo L, et al. Modifiable risk factors associated with prediabetes in men and women: a cross-sectional analysis of the cohort study in primary health care on the evolution of patients with prediabetes (PREDAPS-Study). BMC Fam Pract. 2015;16:5. DOI:10.1186/s12875-014-0216-3
10. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: report of a WHO/IDF consultation. Available at: https://apps.who.int/iris/handle/10665/43588. Accessed: 12.04.2023.
11. ElSayed NA, Aleppo G, Aroda VR, et al.; on behalf of the American Diabetes Association, Introduction and Methodology: Standards of Care in Diabetes–2023. Diabetes Care. 2023;46 (Suppl. 1):S1-4. DOI:10.2337/dc23-Sint
12. Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Comprehensive Type 2 Diabetes Management Algorithm – 2023 Update. Endocr Pract. 2023;29(5):305-40. DOI:10.1016/j.eprac.2023.02.001
13. Guo F, Moellering DR, Garvey WT. Use of HbA1c for diagnoses of diabetes and prediabetes: comparison with diagnoses based on fasting and 2-hr glucose values and effects of gender, race, and age. Metab Syndr Relat Disord. 2014;12(5):258-68. DOI:10.1089/met.2013.0128
14. Gosmanov AR, Wan J. Low positive predictive value of hemoglobin A1c for diagnosis of prediabetes in clinical practice. Am J Med Sci. 2014;348(3):191-4. DOI:10.1097/MAJ.0000000000000223
15. Van't Riet E, Alssema M, Rijkelijkhuizen JM, et al. Relationship between A1C and glucose levels in the general Dutch population: the new Hoorn study. Diabetes Care. 2010;33(1):61-6. DOI:10.2337/dc09-0677
16. Bloomgarden ZT, Inzucchi SE, Karnieli E, Le Roith D. The proposed terminology 'A(1c)-derived average glucose' is inherently imprecise and should not be adopted. Diabetologia. 2008;51(7):1111-4. DOI:10.1007/s00125-008-1027-7
17. Cohen RM, Snieder H, Lindsell CJ, et al. Evidence for independent heritability of the glycation gap (glycosylation gap) fraction of HbA1c in nondiabetic twins. Diabetes Care. 2006;29(8):1739-43. DOI:10.2337/dc06-0286
18. Hostalek U. Global epidemiology of prediabetes – present and future perspectives. Clin Diabetes Endocrinol. 2019;5:5. DOI:10.1186/s40842-019-0080-0
19. Alvarez S, Coffey R, Algotar AM. Prediabetes. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2023. Available at: https://www.ncbi.nlm.nih.gov/books/NBK459332. Accessed: 12.04.2023.
20. Galaviz KI, Weber MB, Suvada KBS, et al. Interventions for Reversing Prediabetes: A Systematic Review and Meta-Analysis. Am J Prev Med. 2022;62(4):614-25. DOI:10.1016/j.amepre.2021.10.020
21. Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403. DOI:10.1056/NEJMoa012512
22. Knowler WC, Hamman RF, Edelstein SL, et al. Diabetes Prevention Program Research Group. Prevention of type 2 diabetes with troglitazone in the Diabetes Prevention Program. Diabetes. 2005;54(4):1150-6. DOI:10.2337/diabetes.54.4.1150
23. Gerstein HC, Yusuf S, Bosch J, et al. Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. Lancet. 2006;368(9541):1096-105. DOI:10.1016/S0140-6736(06)69420-8
24. DeFronzo RA, Tripathy D, Schwenke DC, et al. ACT NOW Study. Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med. 2011;364(12):1104-15. DOI:10.1056/NEJMoa1010949
25. Young LH, Viscoli CM, Curtis JP, et al. IRIS Investigators. Cardiac Outcomes After Ischemic Stroke or Transient Ischemic Attack: Effects of Pioglitazone in Patients With Insulin Resistance Without Diabetes Mellitus. Circulation. 2017;135(20):1882-93. DOI:10.1161/CIRCULATIONAHA.116.024863
26. Lee M, Saver JL, Liao HW, et al. Pioglitazone for Secondary Stroke Prevention: A Systematic Review and Meta-Analysis. Stroke. 2017;48(2):388-93. DOI:10.1161/STROKEAHA.116.013977
27. Chiasson JL, Josse RG, Gomis R, et al. STOP-NIDDM Trail Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002;359(9323):2072-7. DOI:10.1016/S0140-6736(02)08905-5
28. Gerstein HC, Coleman RL, Scott CAB, et al. ACE Study Group. Impact of Acarbose on Incident Diabetes and Regression to Normoglycemia in People With Coronary Heart Disease and Impaired Glucose Tolerance: Insights From the ACE Trial. Diabetes Care. 202;43(9):2242-7. DOI:10.2337/dc19-2046
29. Holman RR, Coleman RL, Chan JCN, et al. ACE Study Group. Effects of acarbose on cardiovascular and diabetes outcomes in patients with coronary heart disease and impaired glucose tolerance (ACE): a randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2017;5(11):877-86. DOI:10.1016/S2213-8587(17)30309-1
30. Perreault L, Davies M, Frias JP, et al. Changes in Glucose Metabolism and Glycemic Status With Once-Weekly Subcutaneous Semaglutide 2.4 mg Among Participants With Prediabetes in the STEP Program. Diabetes Care. 2022;45(10):2396-405. DOI:10.2337/dc21-1785
31. le Roux CW, Astrup A, Fujioka K, et al. SCALE Obesity Prediabetes NN8022-1839 Study Group. 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet. 2017;389(10077):1399-409. DOI:10.1016/S0140-6736(17)30069-7
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Авторы

Н.А. Петунина, Н.С. Мартиросян*, М.В. Хачатуров, М.А. Жутаева, А.А. Шапошникова, Е.В. Карпенко, З.А. Абдулганиева

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*narinarine@list.ru

________________________________________________

Nina A. Petunina, Narine S. Martirosian*, Mikhail V. Khachaturov, Maria A. Zhutaeva, Anastasiia A. Shaposhnikova, Elizaveta V. Karpenko, Zaynab A. Abdulganieva

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*narinarine@list.ru

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