diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM10315diaendo-10315Research ArticleОбзорыReviewСахарный диабет 2 типа у лиц пожилого возраста в практике эндокринолога: фокус на ингибиторы дипептидилпептидазы-4Type 2 diabetes mellitus in elderly patients treated with endocrinologists in clinical practicehttps://orcid.org/0000-0001-9007-4123БирюковаЕлена ВалерьевнаBiryukovaElena V.

Д.м.н., профессор, кафедра эндокринологии и диабетологии

MD, PhD, Professor

lena@obsudim.ruФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова»РоссияMoscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian Federation201928022020226582591Copyright © Бирюкова Е.В., 20192019Бирюкова Е.В.Biryukova E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/10315

Стремительному постарению населения планеты сопутствует масштабная эпидемия сахарного диабета 2 типа (СД2). С возрастом значительно увеличивается распространенность СД2. Целью настоящего обзора стало обобщение данных литературы о СД2 в пожилом и преклонном возрасте. Представлены основные гериатрические синдромы, которые следует учитывать при ведении пациентов старшего возраста (когнитивные нарушения, саркопения, ортостатическая гипотензия, падения, недержание мочи, старческая астения и др.). Анализируются причины для высокого риска развития гипогликемии в пожилом возрасте. Совершенствование подходов к терапии СД2 – приоритетная проблема современной медицины. Сахароснижающая терапия особенно сложна в популяции людей пожилого и старческого возраста из-за повышенного риска гипогликемии, наличия многочисленных сопутствующих заболеваний, проблемы полипрагмазии. Особое внимание уделено рекомендациям по лечению. Основные требования к сахароснижающим препаратам, применяемым у лиц пожилого возраста: низкий риск развития гипогликемий, отсутствие нефро-, гепатотоксичности, сердечно-сосудистая безопасность и простой режим приема. Обсуждаются преимущества и ограничения применения различных групп сахароснижающих препаратов у пациентов пожилого возраста. Подробно рассматривается группа дипептидилпептидазы 4 типа (ДПП-4). Представлены современные данные о механизмах сахароснижающего действия ингибиторов ДПП-4. Рассмотрены возможности использования ситаглиптина у пациентов пожилого возраста. Обсуждается доказательная база ситаглиптина, демонстрирующая очевидные преимущества препарата в лечении СД2 в пожилом возрасте.

A large-scale epidemic of type 2 diabetes mellitus (T2DM) is observed with advanced ageing worldwide. The prevalence of T2DM significantly increases with age. Therefore, this review aimed to summarise the data on T2DM in advanced and older aged patients. The primary geriatric syndromes, which should be considered for the management of older patients (cognitive impairment, sarcopenia, orthostatic hypotension, falls, urinary incontinence, senile asthenia, etc.), are presented. The causes of the high risk for hypoglycaemia in elderly patients are analysed. Improving the treatment for T2DM is a priority of modern medicine. Using antihyperglycaemic therapy is especially difficult in this population due to the high risk of hypoglycaemia and the multi-organ pathology leading to polypharmacy. Therefore, special attention is paid to treatment recommendations. Hypoglycaemic drugs used in elderly patients should be low risk of hypoglycaemia, without nephro- and hepatic toxicity, safe for cardiovascular organs, easy to administer. Furthermore, advantages and limitations of using various groups of hypoglycaemic drugs in elderly patients are discussed. DPP-4 inhibitors are also considered in detail. Modern data on mechanisms of hypoglycaemic action of DPP-4 inhibitors are presented. Possibilities of using sitagliptin in elderly patients were also considered. Finally, evidence-based studies demonstrating the obvious advantages of sitagliptin for the treatment of T2DM in the elderly and advanced aged population are discussed.

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The authors declare that there are no conflicts of interest present.