diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM10334diaendo-10334Research ArticleОбзорыReviewОсобенности высококонцентрированных инсулинов: основные характеристики и результаты исследованийSpecial aspects of concentrated insulins: basic characteristics and research findingsДемидоваТатьяна ЮльевнаDemidovaTatiana Y.

д.м.н., профессор

MD, PhD, Professor

t.y.demidova@gmail.comhttps://orcid.org/0000-0003-4938-1871БалутинаОльга ВладимировнаBalutinaOlga V.

аспирант

MD, PhD student

olgabalutina93@gmail.comРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian Federation201917012020225481490Copyright © Демидова Т.Ю., Балутина О.В., 20192019Демидова Т.Ю., Балутина О.В.Demidova T.Y., Balutina O.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/10334

Появление в клинической практике препаратов высококонцентрированных инсулинов заставляет задуматься о преимуществах их применения у различных групп пациентов c сахарным диабетом. В данной статье мы постарались суммировать результаты последних рандомизированных исследований по эффективности и безопасности концентрированных инсулинов (в частности, инсулина лизпро 200 ЕД/мл, инсулина деглудек 200 ЕД/мл и инсулина гларгин 300 ЕД/мл) и продемонстрировать их влияние на управление сахарным диабетом на примерах из реальной клинической практики. В основном во всех исследованиях случаи тяжелой гипогликемии были достаточно редки (чаще гипогликемия регистрировалась на базис-болюсной схеме инсулинотерапии, включавшей концентрированный базальный инсулин), также статистические улучшения были отмечены и по другим критериям гипогликемии при применении инсулинов с повышенной концентрацией по сравнению с инсулином гларгин 100 Ед/мл. Во всех проанализированных исследованиях действие инсулина гларгин 300 Ед/мл было сопоставимо по своему гипогликемическому эффекту с инсулином гларгин 100 Ед/мл. Также была продемонстрирована более низкая вариабельность гликемии при применении инсулина гларгин 300 Ед/мл по сравнению с гларгином 100 Ед/мл, что делает процесс лечения еще более физиологичным и положительно влияет на прогноз развития микрососудистых осложнений диабета. Результаты рандомизированных исследований сопоставимы с опытом применения в клинической практике и указывают на эффективность и безопасность гипогликемического действия высококонцентрированных инсулинов без повышения риска развития тяжелых гипогликемических реакций.

The appearance of concentrated insulins in clinical practice determines the need to analyze product priorities in appropriate groups of patients with diabetes. The aim of this article is to summarize the literature on concentrated insulins (i.e. insulin lispro 200 units/mL, insulin degludec 200 units/mL, insulin glargine 300 units/mL) from randomized controlled trials, derive guidance on appropriate and safe use of these agents and demonstrate experience in real clinical practice. Severe hypoglycemia in all studies was generally low (though higher with prandial plus concentrated basal analogue therapy), and statistical improvements in other hypoglycemia categories were observed for concentrated basal insulins versus insulin glargine 100 units/mL. In all analyzed data hypoglycemic effect of insulin glargine 300 units/mL was equitable to insulin glargine 100 units/mL. Other important findings demonstrate more constant and prolonged insulin action with low within-subject/ between-day variability for insulin glargine 300 units/mL versus insulin glargine 100 units/mL, therefore, more physiological treatment might prevent from diabetic microvascular complications. The results of randomized trials are comparable with our clinical practice experience and indicate efficacious and safe glucose-lowering properties without risk of severe hypoglycemia.

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