diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13237diaendo-13237Research ArticleОБЗОРЫREVIEWSОжирение у больных сахарным диабетом 1 типа: причины и следствияObesity in Patients with Type 1 Diabetes: Causes and Consequenceshttps://orcid.org/0000-0002-5407-8722КлимонтовВ. В.KlimontovV. V.

Климонтов Вадим Валерьевич - д.м.н., профессор; eLibrary SPIN: 1734-4030; WoS Researcher ID: R-7689-2017; Scopus Author ID: 8295977000.

630060, Новосибирск, ул. Тимакова, д. 2

Vadim V. Klimontov - MD, PhD, Professor; eLibrary SPIN: 1734-4030; WoS Researcher ID: R-7689-2017; Scopus Author ID: 8295977000.

2 Timakov street, 630060 Novosibirsk

klimontov@mail.ruhttps://orcid.org/0009-0000-6565-7466ЮшинА. Ю.YushinA. Yu.

Юшин Антон Юрьевич - м.н.с.

Новосибирск

Аnton Y. Yushin - MD.

Novosibirsk

antyush@yandex.ruНаучно-исследовательский институт клинической и экспериментальной лимфологии — филиал ФГБНУ Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наукРоссияResearch Institute of Clinical and Experimental Lymphology – branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of SciencesRussian Federation202509102025284394403Copyright © Климонтов В.В., Юшин А.Ю., 20252025Климонтов В.В., Юшин А.Ю.Klimontov V.V., Yushin A.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/13237

Ожирение у больных сахарным диабетом 1 типа (СД1) становится все более важной проблемой диабетологии. По данным разных исследований, распространенность избыточной массы тела и ожирения среди пациентов с СД1 варьирует от 15 до 50%. Около четверти больных СД1 имеют метаболический синдром. С одной стороны, увеличение массы тела у пациентов с СД1 отражает общепопуляционный тренд. С другой стороны, увеличению массы тела способствуют факторы, специфичные для диабета, такие как базис-болюсная инсулинотерапия, хроническая передозировка инсулина, гипогликемии, а также психологические проблемы, связанные с заболеванием. Связь СД1 и ожирения может быть двунаправленной. Установлено, что избыточная масса тела и ожирение повышают риск развития СД1, вероятно, способствуя аутоиммунной деструкции бета-клеток. Лица с избыточной массой тела и ожирением, по сравнению с больными с нормальной массой тела, чаще имеют инсулинорезистентность, дислипидемию и нуждаются в более высоких дозах инсулина для достижения целевых параметров гликемического контроля. Ожирение у лиц с СД1 является фактором риска диабетических микроангиопатий, артериальной гипертензии, хронической болезни почек, хронической сердечной недостаточности, сердечно-сосудистых событий, неалкогольной жировой болезни печени и ассоциировано с повышенной смертностью. Следовательно, поддержание нормальной массы тела следует считать важной задачей при лечении СД1. Обучение, диета с умеренным ограничением калорий и физическая активность являются основой стратегии профилактики и лечения ожирения у лиц с СД1. В качестве перспективных терапевтических опций рассматриваются агонисты глюкагон-подобного пептида-1, двойные агонисты глюкагон-подобного пептида-1 и глюкозозависимого инсулинотропного полипептида, ингибиторы глюкозо-натриевого котранспортера-2, метформин, однако данных по эффективности и безопасности применения этих лекарств при СД1 пока недостаточно. Накапливается опыт выполнения бариатрических вмешательств у лиц с СД1 и морбидным ожирением. Дальнейшие исследования необходимы для создания программ профилактики и лечения ожирения у пациентов с СД1.

Obesity in patients with type 1 diabetes (T1D) is an increasingly important problem in diabetology. According to recent studies, the prevalence of overweight and obesity among patients with T1D varies from 15 to 50%. About a quarter of patients with T1D have metabolic syndrome. On the one hand, weight gain in patients with T1D reflects a general population trend. On the other hand, diabetes-related factors such as basal-bolus insulin therapy, chronic insulin overdose, hypoglycemia, and psychological problems associated with the disease can be promoters of weight gain. The relationship between T1D and obesity can be bidirectional. It has been established that overweight and obesity increase the risk of T1D, probably contributing to the autoimmune destruction of beta cells. Individuals with overweight and obesity, compared with patients with normal body weight, more often have insulin resistance, dyslipidemia and require higher doses of insulin to achieve targets of glycemic control. Obesity in individuals with T1D a risk factor for diabetic microvascular complications, arterial hypertension, chronic kidney disease, chronic heart failure, cardiovascular events, non-alcoholic fatty liver disease, and is associated with increased mortality. Therefore, maintaining normal body weight should be considered as an important option in the management of T1D. Education, moderate calorie restriction diet, and physical activity are the basis of the strategy for the prevention and treatment of obesity in individuals with T1D. Glucagon-like peptide-1 agonists, dual agonists of glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, sodium-glucose cotransporter 2 inhibitors, and metformin are considered promising therapeutic options; however, data on the efficacy and safety of these drugs in patients with T1D are still limited. Experience in performing bariatric interventions in individuals with T1D and morbid obesity is accumulating. Further research is needed to create programs for the prevention and treatment of obesity in patients with T1D.

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