Сахарный диабет и хронические заболевания печени. Обзор литературы (часть 2): особенности лечения
________________________________________________
Kalmykova Z.A., Kononenko I.V., Mayorov A.Yu. Diabetes mellitus and chronic liver diseases. Literature review (part 2): treatment features. Therapeutic Archive. 2019; 91 (12): 115–121. DOI: 10.26442/00403660.2019.12.000166
Материалы доступны только для специалистов сферы здравоохранения. Авторизуйтесь или зарегистрируйтесь.
Рассматриваются вопросы коррекции углеводного обмена у пациентов с ХЗП, приведены основные группы современных сахароснижающих препаратов, механизмы их действия, влияние на физиологию печени, возможности использования каждой из этих фармакологических групп у пациентов с нарушенной функцией печени. Перечислены современные подходы и возможности медикаментозного воздействия на процесс фиброгенеза при ХЗП, влияние этих препаратов на углеводный обмен.
Ключевые слова: сахарный диабет, хронические заболевания печени, печеночная недостаточность, цирроз печени, вирусные гепатиты, алкогольная болезнь печени, неалкогольная жировая болезнь печени, сахароснижающие препараты.
________________________________________________
Diabetes mellitus (DM) and chronic liver disease (CLD) are pathological conditions associated with each other and reaching epidemic proportions. There is a strong pathogenetic relationship of carbohydrate metabolism disorders and a number of CLD. Common mechanisms that provoke metabolic and autoimmune disorders in the development of various CLD, leading to steatosis, insulin resistance (IR), impaired glucose tolerance and the development of DM are described. Effective glycemic control can have a beneficial effect on the treatment of these patients, and, conversely, there is evidence of a positive effect of CLD therapy on carbohydrate metabolism. This review discusses the correction of carbohydrate metabolism in patients with CLD, the main groups of modern hypoglycemic drugs, mechanisms of their action, the impact on the physiology of the liver, the possibility of using each of these pharmacological groups in patients with impaired liver function. The modern approaches and possibilities of drug effects on the process of fibrogenesis in CLD, the effect of these drugs on carbohydrate metabolism are listed.
Keywords: diabetes mellitus, chronic liver disease, liver failure, liver cirrhosis, viral hepatitis, alcoholic liver disease, nonalcoholic fatty liver disease, hypoglycemic agents.
2. Дедов И.И., Шестакова М.В. Cахарный диабет типа 2. От теории к практике. М., 2016 [Dedov II, Shestakova MV. Type 2 diabetes. From theory to practice. Moscow, 2016 (In Russ.)].
3. British National Formulary (BNF) 70. Published 2015. Available at: https://pharm.reviews/images/statyi/british-national-formulary-2015.pdf (accessed Aug 7, 2018).
4. Арутюнов А.Т., Иваников И.О., Сюткин В.Е. Диагностика и лечение хронических заболеваний печени. М.: Принт-Ателье, 2005. 303 с. ISBN 5-98107-020-X [Arutyunov AT, Ivanikov IO, Syutkin VE. Diagnosis and treatment of chronic liver diseases. Moscow: Print-Atelier, 2005. 330 p. ISBN 5-98107-020-X (In Russ.)].
5. Zhang X, Harmsen WS, Mettler TA, et al. Continuation of metformin use after a diagnosisь of cirrhosis significantly improves survival of patients with diabetes. Hepatology. 2014;60(6):2008-16. doi: 10.1002/hep.27199
6. Khan R, Foster R, Chowdhury A. Managing Diabetes in Patients with Chronic Liver Disease. Postgrad Med. 2012;124(4):130-7. doi: 10.3810/pgm.2012.07.2574
7. Gangopadhyay KK. Consensus Statement on Dose Modifications of Antidiabetic Agents in Patients with Hepatic Impairment. Indian J Endocr Metab. 2017. doi: 10.4103/ijem.IJEM
8. Baliunas O, Taylor J, Irving H, et al. Alcohol as a Risk Factor for Type 2 Diabetes. Diabetes Care. 2009;32(11):2123-32. doi: 10.2337/dc09-0227
9. Bhat A. Systematic review: Preventive and therapeutic applications of metformin in liver disease. World J Hepatol. 2015;7(12):1652. doi: 10.4254/wjh.v7.i12.1652
10. Kawamori R, Kadowaki T, Onjic M, et al. Hepatic safety profile and glycemic control of pioglitazone in more than 20,000 patients with type 2 diabetes mellitus: Postmarketing surveillance study in Japan. Diabetes Res Clin Pract. 2007;76(2):229-35.
11. Bril F, Kalavalapalli S, Clark VC, Lomonaco RS. Response to Pioglitazone in Patients With Nonalcoholic Steatohepatitis With vs Without Type 2 Diabetes. Clin Gastroenterol Hepatol. 2018;16(4):558-66.
12. Регистр лекарственных средств России РЛС [Electronic resource]. Доступно по ссылке: https://www.rlsnet.ru (дата обращения: 07.08.2018) [Register of medicines of Russia [Electronic resource]. Available at: https://www.rlsnet.ru (accessed: 07.08.2018) (In Russ.)].
13. Tolman KG, Fonseca V, Dalpiaz A, Tan MH. Spectrum of Liver Disease in Type 2 Diabetes and Management of Patients With Diabetes and Liver Disease. Diabetes Care. 2007;30(3):734-43. doi: 10.2337/dc06-1539
14. Gentile S, Turco S, Guarino G, et al. Effect of treatment with acarbose and insulin in patients with non-insulin-dependent diabetes mellitus associated with non-alcoholic liver cirrhosis. Diabetes Obes Metab. 2001;3(1):33-40.
15. Gentile S, Guarino G, Romano M, et al. A randomized controlled trial of acarbose in hepatic encephalopathy. Clin Gastroenterol Hepatol. 2005;3(2):184-91.
16. Cosmi F, Shen L, Magnoli M, et al. Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes. Eur J Heart Fail. 2018;20(5):888-95. doi: 10.1002/ejhf.1146
17. Kupčová V, Arold G, Roepstorff C, et al. Insulin degludec: Pharmacokinetic properties in subjects with hepatic impairment. Clin Drug Investig. 2014;34(2):127-33. doi: 10.1007/s40261-013-0154-1
18. Gentile S, Guarino G, Strollo F, et al. Lispro insulin in people with non-alcoholic liver cirrhosis and type 2 diabetes mellitus. Diabetes Res Clin Pract. 2016;113:179-86. doi: 10.1016/j.diabres.2015.12.006
19. García-Compeán D, González-González JA, Lavalle-González FJ, et al. Hepatogenous diabetes: Is it a neglected condition in chronic liver disease? World J Gastroenterol. 2016;22(10):2869-74. doi: 10.3748/wjg.v22.i10.289
20. Scheen AJ. Pharmacokinetics in patients with chronic liver disease and hepatic safety of incretin-based therapies for the management of type 2 diabetes mellitus. Clin Pharmacokinet. 2014;53(9):773-85. doi: 10.1007/s40262-014-0157-y
21. Giorda CB, Nada E, Tartaglino B. Pharmacokinetics, safety, and efficacy of DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes mellitus and renal or hepatic impairment. A systematic review of the literature. Endocrine. 2014;46(3):406-19. doi:10.1007/s12020-014-0179-0
22. Дедов И.И., Шестакова М.В., Майоров А.Ю. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Сахарный диабет. 2017;20(1S):1-112 [Dedov II, Shestakova MV, Mayorov AYu. Algorithms of specialized medical care for patients with diabetes. Diabetes. 2017;20(1S):1-112 (In Russ.)]. doi: 10.14341/DM20171S8
23. Ивашкин В.Т., Ющук М.В. Клинические рекомендации Российской гастроэнтерологической ассоциации и Российского общества по изучению печени по диагностике и лечению взрослых больных гепатитом В. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2014;(3):5-19 [Ivashkin VT, Yuschuk MV. Clinical guidelines of the Russian gastroenterological Association and the Russian society on studying of liver diseases on diagnostics and treatment of adult patients with hepatitis B. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2014;(3):5-19 (In Russ.)].
24. Morales AL, Junga Z, Singla MB, et al. Hepatitis C eradication with sofosbuvir leads to significant metabolic changes. World J Hepatol. 2016;8(35):1557-63. doi: 10.4254/wjh.v8.i35.1557
25. Ikeda A, Ikeda K, Takai A, et al. Hepatitis C Treatment with Sofosbuvir and Ledipasvir Accompanied by Immediate Improvement in Hemoglobin A1c. Digestion. 2017;96(4):228-30. doi: 10.1159/000484237
26. Hammerstad SS, Grock SF, Lee HJ, Hasham A. Diabetes and hepatitis C: a two-way association. Front Endocrinol. 2015;6(September). doi: 10.3389/fendo.2015.00134
27. Li Q, Xu B, Michie SA, Rubins KH, et al. Interferon alpha initiates type 1 diabetes in nonobese diabetic mice. PNAS. 2008;105(34):12439-44.
28. Ивашкин В.Т., Маевская М.В., Павлов Ч.С. и др. Клинические рекомендации Российского общества по изучению печени по ведению взрослых пациентов с алкогольной болезнью печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2017;27(6):20-40 [Ivashkin VT, Mayevskaya MV, Pavlov CS, et al. Clinical recommendations of the Russian Society for the Study of the Liver on the management of adult patients with alcoholic liver disease. Rossiiskii Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2017;27(6):20-40 (In Russ.)]. doi: 10.22416/1382-4376-2017-27-6-20-40
29. Han SJ, Kim HJ, Kim DJ, et al. Effects of pentoxifylline on proteinuria and glucose control in patients with type 2 diabetes: a prospective randomized double-blind multicenter study. Diabetol Metab Syndr. 2015;7:64. doi: 10.1186/s13098-015-0060-1
30. Chalasani N, Younossi Z, Lavine JE, et al. The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.
31. Mudaliar S, Robert R, Henry AJS. Efficacy and Safety of the Farnesoid X Receptor Agonist Obeticholic Acid in Patients With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease. Gastroenterology. 2013;145(3):574-82. doi: 10.1053/j.gastro.2013.05.042
32. Смирнова О.М. Сахарный диабет и неалкогольная болезнь печени. Медицинский альманах. 2014:57-61 [Smirnova OM. Diabetes and non-alcoholic liver disease. Medical Almanac. 2014:57-61 (In Russ.)]
33. Скляник И.А., Шамхалова М.Ш., Шестакова М.В. Посттрансплантационный сахарный диабет. Обзор литературы. Сахарный диабет. 2015;18(2):20-31 [Sklyanik IA, Shamkhalova MS, Shestakova MV. Post-transplantation diabetes mellitus: an overview. Diabetes Mellit. 2015;18(2):20-31 (In Russ.)]. doi: 10.14341/DM2015220-31
________________________________________________
1. Gupta NK, Lewis JH. Review article: the use of potentially hepatotoxic drugs in patients with liver disease. Aliment Pharmacol Ther. 2008;28(9):1021-41. doi: 10.1111/j.1365-2036.2008.03822.x1
2. [Dedov II, Shestakova MV. Type 2 diabetes. From theory to practice. Moscow, 2016 (In Russ.)].
3. British National Formulary (BNF) 70. Published 2015. Available at: https://pharm.reviews/images/statyi/british-national-formulary-2015.pdf (accessed Aug 7, 2018).
4. [Arutyunov AT, Ivanikov IO, Syutkin VE. Diagnosis and treatment of chronic liver diseases. Moscow: Print-Atelier, 2005. 330 p. ISBN 5-98107-020-X (In Russ.)].
5. Zhang X, Harmsen WS, Mettler TA, et al. Continuation of metformin use after a diagnosisь of cirrhosis significantly improves survival of patients with diabetes. Hepatology. 2014;60(6):2008-16. doi: 10.1002/hep.27199
6. Khan R, Foster R, Chowdhury A. Managing Diabetes in Patients with Chronic Liver Disease. Postgrad Med. 2012;124(4):130-7. doi: 10.3810/pgm.2012.07.2574
7. Gangopadhyay KK. Consensus Statement on Dose Modifications of Antidiabetic Agents in Patients with Hepatic Impairment. Indian J Endocr Metab. 2017. doi: 10.4103/ijem.IJEM
8. Baliunas O, Taylor J, Irving H, et al. Alcohol as a Risk Factor for Type 2 Diabetes. Diabetes Care. 2009;32(11):2123-32. doi: 10.2337/dc09-0227
9. Bhat A. Systematic review: Preventive and therapeutic applications of metformin in liver disease. World J Hepatol. 2015;7(12):1652. doi: 10.4254/wjh.v7.i12.1652
10. Kawamori R, Kadowaki T, Onjic M, et al. Hepatic safety profile and glycemic control of pioglitazone in more than 20,000 patients with type 2 diabetes mellitus: Postmarketing surveillance study in Japan. Diabetes Res Clin Pract. 2007;76(2):229-35.
11. Bril F, Kalavalapalli S, Clark VC, Lomonaco RS. Response to Pioglitazone in Patients With Nonalcoholic Steatohepatitis With vs Without Type 2 Diabetes. Clin Gastroenterol Hepatol. 2018;16(4):558-66.
12.[Electronic resource]. Available at: https://www.rlsnet.ru (accessed: 07.08.2018) (In Russ.)].
13. Tolman KG, Fonseca V, Dalpiaz A, Tan MH. Spectrum of Liver Disease in Type 2 Diabetes and Management of Patients With Diabetes and Liver Disease. Diabetes Care. 2007;30(3):734-43. doi: 10.2337/dc06-1539
14. Gentile S, Turco S, Guarino G, et al. Effect of treatment with acarbose and insulin in patients with non-insulin-dependent diabetes mellitus associated with non-alcoholic liver cirrhosis. Diabetes Obes Metab. 2001;3(1):33-40.
15. Gentile S, Guarino G, Romano M, et al. A randomized controlled trial of acarbose in hepatic encephalopathy. Clin Gastroenterol Hepatol. 2005;3(2):184-91.
16. Cosmi F, Shen L, Magnoli M, et al. Treatment with insulin is associated with worse outcome in patients with chronic heart failure and diabetes. Eur J Heart Fail. 2018;20(5):888-95. doi: 10.1002/ejhf.1146
17. Kupčová V, Arold G, Roepstorff C, et al. Insulin degludec: Pharmacokinetic properties in subjects with hepatic impairment. Clin Drug Investig. 2014;34(2):127-33. doi: 10.1007/s40261-013-0154-1
18. Gentile S, Guarino G, Strollo F, et al. Lispro insulin in people with non-alcoholic liver cirrhosis and type 2 diabetes mellitus. Diabetes Res Clin Pract. 2016;113:179-86. doi: 10.1016/j.diabres.2015.12.006
19. García-Compeán D, González-González JA, Lavalle-González FJ, et al. Hepatogenous diabetes: Is it a neglected condition in chronic liver disease? World J Gastroenterol. 2016;22(10):2869-74. doi: 10.3748/wjg.v22.i10.289
20. Scheen AJ. Pharmacokinetics in patients with chronic liver disease and hepatic safety of incretin-based therapies for the management of type 2 diabetes mellitus. Clin Pharmacokinet. 2014;53(9):773-85. doi: 10.1007/s40262-014-0157-y
21. Giorda CB, Nada E, Tartaglino B. Pharmacokinetics, safety, and efficacy of DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes mellitus and renal or hepatic impairment. A systematic review of the literature. Endocrine. 2014;46(3):406-19. doi:10.1007/s12020-014-0179-0
22. [Dedov II, Shestakova MV, Mayorov AYu. Algorithms of specialized medical care for patients with diabetes. Diabetes. 2017;20(1S):1-112 (In Russ.)]. doi: 10.14341/DM20171S8
23. [Ivashkin VT, Yuschuk MV. Clinical guidelines of the Russian gastroenterological Association and the Russian society on studying of liver diseases on diagnostics and treatment of adult patients with hepatitis B. Rossiyskiy Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2014;(3):5-19 (In Russ.)].
24. Morales AL, Junga Z, Singla MB, et al. Hepatitis C eradication with sofosbuvir leads to significant metabolic changes. World J Hepatol. 2016;8(35):1557-63. doi: 10.4254/wjh.v8.i35.1557
25. Ikeda A, Ikeda K, Takai A, et al. Hepatitis C Treatment with Sofosbuvir and Ledipasvir Accompanied by Immediate Improvement in Hemoglobin A1c. Digestion. 2017;96(4):228-30. doi: 10.1159/000484237
26. Hammerstad SS, Grock SF, Lee HJ, Hasham A. Diabetes and hepatitis C: a two-way association. Front Endocrinol. 2015;6(September). doi: 10.3389/fendo.2015.00134
27. Li Q, Xu B, Michie SA, Rubins KH, et al. Interferon alpha initiates type 1 diabetes in nonobese diabetic mice. PNAS. 2008;105(34):12439-44.
28. [Ivashkin VT, Mayevskaya MV, Pavlov CS, et al. Clinical recommendations of the Russian Society for the Study of the Liver on the management of adult patients with alcoholic liver disease. Rossiiskii Zhurnal Gastroenterologii, Gepatologii, Koloproktologii. 2017;27(6):20-40 (In Russ.)]. doi: 10.22416/1382-4376-2017-27-6-20-40
29. Han SJ, Kim HJ, Kim DJ, et al. Effects of pentoxifylline on proteinuria and glucose control in patients with type 2 diabetes: a prospective randomized double-blind multicenter study. Diabetol Metab Syndr. 2015;7:64. doi: 10.1186/s13098-015-0060-1
30. Chalasani N, Younossi Z, Lavine JE, et al. The Diagnosis and Management of Nonalcoholic Fatty Liver Disease: Practice Guidance From the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-57.
31. Mudaliar S, Robert R, Henry AJS. Efficacy and Safety of the Farnesoid X Receptor Agonist Obeticholic Acid in Patients With Type 2 Diabetes and Nonalcoholic Fatty Liver Disease. Gastroenterology. 2013;145(3):574-82. doi: 10.1053/j.gastro.2013.05.042
32. [Smirnova OM. Diabetes and non-alcoholic liver disease. Medical Almanac. 2014:57-61 (In Russ.)]
33. [Sklyanik IA, Shamkhalova MS, Shestakova MV. Post-transplantation diabetes mellitus: an overview. Diabetes Mellit. 2015;18(2):20-31 (In Russ.)]. doi: 10.14341/DM2015220-31
ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава России, Москва, Россия
________________________________________________
Z.A. Kalmykova, I.V. Kononenko, A.Yu. Mayorov
Endocrinology Research Centre, Moscow, Russia