diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13079diaendo-13079Research ArticleОбзорыReviewРанняя интенсификация терапии сахарного диабета 2 типа и достижение целевого уровня гликогемоглобина HbA1c — необходимые факторы для снижения риска микро- и макрососудистых осложненийEarly intensification of therapy for type 2 diabetes mellitus and achievement of the target level of glycohemoglobin HbA1c are necessary factors to reduce the risk of micro- and macrovascular complicationshttps://orcid.org/0000-0002-3433-0142ШамхаловаМ. Ш.ShamkhalovaM. S.

Шамхалова Минара Шамхаловна – доктор медицинских наук.

117036, Москва, ул. Дм. Ульянова, д. 11

Minara S. Shamkhalova - MD, PhD.

11 Dm. Ulyanova street, 117036 Moscow

shamkhalova@mail.ruhttps://orcid.org/0000-0002-3443-7206СухареваО. Ю.SukharevaO. Y.

Сухарева Ольга Юрьевна – кандидат медицинских наук.

Москва

Olga Y. Sukhareva - MD, PhD.

Moscow

olgasukhareva@mail.ruГНЦ РФ ФГБУ «Национальный медицинский исследовательский центр эндокринологии»РоссияEndocrinology Research CentreRussian Federation202317082023264343351Copyright © Шамхалова М.Ш., Сухарева О.Ю., 20232023Шамхалова М.Ш., Сухарева О.Ю.Shamkhalova M.S., Sukhareva O.Y.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/13079

Контроль сахарного диабета 2 типа (СД2) требует многофакторного поведенческого и фармакологического лечения для предотвращения развития или замедления прогрессирования осложнений. Основные характеристики СД2 — гипергликемия и инсулинорезистентность в сочетании с окислительным стрессом, низкоактивным воспалением, эпигенетическими изменениями, генетической предрасположенностью, активацией ренин-ангиотензин-альдостероновой системы, вызывая дисфункцию эндотелия, с самых ранних стадий ответственны за метаболическую среду, увеличивающую сосудистый риск у пациентов. Почти все пациенты с СД2 находятся в зоне высокого и очень высокого сердечно-сосудистого риска. Крупнейшие исследования конца ХХ — начала XXI вв. продемонстрировали значительное снижение числа осложнений при интенсивной терапии на ранней стадии заболевания и «эффект наследия» с долгосрочным историческим значением контроля HbA1c во время их обсервационных продолжений. Снижение уровня HbA1c также может играть роль в опосредовании положительного эффекта в отношении риска сердечно-сосудистых осложнений, наблюдаемого при применении новых сахароснижающих препаратов. Стремления к гликемическому контролю и к органоспецифической защите не исключают, а дополняют друг друга. Переоценка индивидуальных целей гликемии и их достижение через регулярные промежутки времени с ранней интенсификацией терапии являются ключевыми для преодоления клинической инертности.

Control of type 2 diabetes mellitus (T2DM) requires multifactorial behavioral and pharmacological treatment to prevent the development or slow the progression of complications. The main characteristics of T2DM — hyperglycemia and insulin resistance, combined with oxidative stress, low-level inflammation, epigenetic changes, genetic predisposition, activation of the renin-angiotensin-aldosterone system, causing endothelial dysfunction, are responsible for the metabolic environment that increases vascular risk in patients. Almost all patients with type 2 diabetes are at high and very high cardiovascular risk. The largest studies of the late XX-early XXI centuries. demonstrated a significant reduction in complications with intensive care early in the course of the disease and a «legacy effect» with the long-term historical value of HbA1c control during their observational follow-ups. The decrease in HbA1c may also play a role in mediating the positive effect on cardiovascular risk observed with the use of new hypoglycemic agents. The desire for glycemic control and the desire for organ-specific protection are not mutually exclusive, but complementary. Reassessing individual glycemic goals and achieving them at regular intervals with early intensification of therapy is key to overcoming clinical inertia.

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