diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM2003422-27diaendo-7564Research ArticleКардиологияCardiologyКонтроль гликемии и сахароснижающая терапия у больных сахарным диабетом 2 типа с сердечно-сосудистыми заболеваниями (обзор многоцентровых рандомизированных клинических исследований)Glycemia control and glucose-lowering therapy in patients with type 2 diabetes mellitus and cardiovascular disease (review of multicenter randomized trials)https://orcid.org/0000-0003-2421-9165КакоринСергей ВалентиновичKakorinSergey V.

к.м.н.

MD, PhD

kakorin-s@yandex.ruhttps://orcid.org/0000-0001-5451-3803ИскандарянРубен АлександровичIskandaryanRuben A.

к.б.н.

PhD

kot@zelenyi-kot.ruМкртумянАшот МусаеловичMkrtumyanAshot M.

д.м.н., профессор

MD, PhD, Professor

endodiab.mgmsu@mail.ruГБУЗ Городская клиническая больница № 4 Департамента здравоохранения г. МосквыРоссияMoscow City Clinical Hospital № 4Russian FederationГБОУ ВПО Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияThe Russian National Research Medical University named after N.I. PirogovRussian FederationГБОУ ВПО Московский государственный медико-стоматологический университет имени А.И. ЕвдокимоваРоссияMoscow State University of Medicine and Dentistry named after A.I. EvdokimovRussian Federation201621062016193221228Copyright © Какорин С.В., Искандарян Р.А., Мкртумян А.М., 20162016Какорин С.В., Искандарян Р.А., Мкртумян А.М.Kakorin S.V., Iskandaryan R.A., Mkrtumyan A.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/7564

Применение современных методов лечения сердечно-сосудистых заболеваний (ССЗ), в том числе фармакологической терапии, увеличивает продолжительность и улучшает качество жизни пациентов как с нормальным углеводным обменом (НУО), так и с сахарным диабетом 2 типа (СД2). В статье представлен обзор научных публикаций, посвященных контролю гликемии и выбору тактики сахароснижающей терапии у больных СД2, имеющих ССЗ. Агрессивная тактика снижения гликемии у больных СД2 с уже имеющимися ССЗ приводит к увеличению частоты сердечно-сосудистых осложнений (ССО) и сердечно-сосудистой смертности (ССС), что связано с гипогликемией (ГГ). Для предупреждения развития ГГ, согласно последним рекомендациям, целевым уровнем гликированного гемоглобина (HbA1c) считается величина менее 7,0%, у пожилых пациентов ее устанавливают на уровне 7,5–8,0%. Рекомендуемый целевой уровень глюкозы крови составляет 7,7–10,0 ммоль/л. Результаты рандомизированных клинических исследований (РКИ) показали неблагоприятные эффекты производных сульфонилмочевины (СМ) второго поколения в виде развития частых эпизодов ГГ, повышения частоты ССО и летальности. В сравнении с препаратами СМ второго поколения и инсулином, метформин снижает риск ССЗ. Тиазолидиндионы у больных с ССЗ в настоящее время не применяются. Безопасность аналогов глюкагоноподобного пептида 1 типа (ГПП-1) и ингибиторов натрий-глюкозного котранспортера 2 типа (SGLT-2) продолжает изучаться. При неэффективности терапии метформином в качестве дополнительного антигипергликемического (АГГ) средства целесообразно назначение ингибиторов дипептидилпептидазы 4 типа (ДПП-4). Метформин противопоказан больным с тяжелой хронической сердечной недостаточностью (ХСН) и острым инфарктом миокарда (ОИМ) из-за риска развития лактатацидоза при тканевой гипоксии. Инсулин остается основным препаратом коррекции сахара крови у больных ССЗ с хронической болезнью почек (ХБП), тяжелой ХСН и острыми клиническими состояниями.

The use of modern pharmaceuticals and cardiovascular disease (CVD) treatment methods has increased life expectancy and improved the quality of life of both patients with normal carbohydrate metabolism and diabetes mellitus (DM). This study provides a review of the literature on glycaemic control and choice of glucose-lowering therapy in patients with type 2 DM (T2DM) and CVD. According to the latest recommendations for the prevention of CVD, the target level of glycated haemoglobin (HbA1c) should be less than 7.0% and 7.5%–8.0% in older patients to decrease the risk of hypoglycaemia. The target blood glucose level is 7.7–10 mmol/L. The results of randomized clinical trials (RCTs) revealed that the adverse effects of second-generation sulfonylureas include critical hypoglycaemia episodes and increases in CVD-associated complications and mortality. Metformin reduces the risk of CVD in comparison with second-generation sulfonylurea derivates and insulin. Thiazolidinediones are not currently used for patients with CVD, and the safety of GLP-1 analogues and SGLT-2 inhibitors is still under investigation. When metformin therapy is ineffective, DPP-4 inhibitors should be prescribed and renal function should be monitored. Metformin is contra-indicated in patients with severe chronic heart failure (CHF) and acute myocardial infarction (AMI) because of the risk of lactic acidosis with tissue hypoxia. Thus, insulin is the drug of choice for glycaemic control in CVD patients with chronic kidney disease, severe heart failure or other acute clinical conditions.

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