diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12840diaendo-12840Research ArticleОбзорыReviewГипогликемические состояния у больных сахарным диабетом 2 типа – церебральные, когнитивные, психосоциальные и клинические аспектыHypoglycemia in type 2 diabetes mellitus patients — cerebral, cognitive, psychosocial and clinical aspectshttps://orcid.org/0000-0003-2373-2231АнтоноваК. В.AntonovaK. V.

Антонова Ксения Валентиновна, доктор медицинских наук, ведущий научный сотрудник

125367, Москва, Волоколамское шоссе, д. 80

Researcher ID: J-9971-2016;

Scopus Author ID: 7004672742;

eLibrary SPIN: 7737-4712

Ksenia V. Antonova, MD, PhD, leading research associate

80, Volokolamskoe highway, Moscow, 125367

Researcher ID: J-9971-2016;

Scopus Author ID: 7004672742;

eLibrary SPIN: 7737-4712

kseniya.antonova@mail.ruhttps://orcid.org/0000-0001-7562-4991ЛагодаО. В.LagodaO. V.

Лагода Ольга Викторовна, кандидат медицинских наук, старший научный сотрудник

Москва

Researcher ID: C-5395-2012;

Scopus Author ID: 6507370001;

eLibrary SPIN: 1789-4735

Olga V. Lagoda, MD, PhD, senior research associate

Moscow

Researcher ID: C-5395-2012;

Scopus Author ID: 6507370001;

eLibrary SPIN: 1789-4735

angionev@gmail.comhttps://orcid.org/0000-0002-5883-8119ТанашянМ. М.TanashyanM. M.

Танашян Маринэ Мовсесовна, доктор медицинских наук, профессор, член-корреспондент РАН

Москва

Researcher ID: F-8483-2014;

Scopus Author ID: 6506228066;

eLibrary SPIN: 7191-1163

Marine M. Tanashyan, MD, PhD, Professor

Moscow

Researcher ID: F-8483-2014;

Scopus Author ID: 6506228066;

eLibrary SPIN: 7191-1163

mtanashyan@neurology.ruНаучный центр неврологииРоссияResearch center of neurologyRussian Federation202223062022253288298Copyright © Антонова К.В., Лагода О.В., Танашян М.М., 20222022Антонова К.В., Лагода О.В., Танашян М.М.Antonova K.V., Lagoda O.V., Tanashyan M.M.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/12840

В обзоре отражаются современные представления о проблеме гипогликемии у больных сахарным диабетом (CД), эволюция клинических и лабораторных подходов к диагностике и актуальная классификация. Наибольшее значение имеет влияние гипогликемии на повышение риска развития сердечно-сосудистых заболеваний и смерти, в частности нарушений мозгового кровообращения. В статье обсуждаются как вопросы патогенеза повреждения вещества мозга при нейрогликопении, так и семиотики неврологических нарушений у этой категории пациентов. Освещены аспекты влияния гликопении на церебральный метаболизм, формирования контррегуляторного ответа и нарушения распознавания гипогликемии, а также современные возможности использования методов нейровизуализации для проведения дифференциальной диагностики в сложных случаях тяжелой гипогликемии. Представлены данные об эпидемиологии нейрокогнитивных нарушений у больных СД и их связи с гипогликемическими состояниями, а также психосоциальные последствия гипогликемии как для самого пациента, так и для родственников и медицинского персонала. Не теряет своей актуальности поиск путей снижения бремени гипогликемии с позиции эффективной и безопасной стратегии лечения больных с СД 2 типа, в связи с чем приведены данные по частоте и распространенности гипогликемических состояний различной тяжести при использовании отдельных классов сахароснижающих препаратов. Клиническое определение терапевтического подхода, позволяющего максимизировать метаболический контроль при минимизации риска гипогликемии, определяет возможности персонализированного управления СД.

The review article describes modern approaches to hypoglycemia in diabetes mellitus (DM) patients, its clinical and laboratory diagnostics, and its current classification. Hypoglycemia has the highest impact on cardiovascular morbidity and mortality, including stroke. Cerebral damage in neuroglycopenia, as well as neurological aspects in this group of patients, are discussed. The authors describe glycopenia’s influence on cerebral metabolism, counter-regulatory response, and impaired hypoglycemia recognition, as well as modern neuroimaging techniques that may enhance differential diagnostics in complex cases. The epidemiology of neurocognitive disorders in DM patients and their association with hypoglycemic conditions is outlined, together with psychosocial aspects of its consequences — both for the patient and relatives and for the medical professionals. The search for ways to reduce the burden of hypoglycemia from the standpoint of an effective and safe strategy for treating patients with type 2 diabetes does not lose its relevance, and therefore data on the prevalence of hypoglycemic conditions of varying severity when using certain classes of hypoglycemic drugs are presented. A therapeutic approach that maximizes metabolic control while reducing hypoglycemia to a minimum may determine further possibilities for personalized DM management.

 

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