diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/7875diaendo-8296Research ArticleДиагностика, контроль, лечениеDiagnosis, control, treatmentНовые возможности достижения целевого гликемического контроля у пациентов с сахарным диабетом 2 типа с использованием комбинированной терапии лираглутидом и инсулином детемир: основания для альянсаCombined insulin detemir and liraglutide therapy in type 2 diabetic patients: a base for an alliancehttps://orcid.org/0000-0002-6762-5238РуяткинаЛюдмила АлександровнаRuyatkinaLyudmila Alexandrovna

Профессор, д.м.н., профессор кафедры неотложной терапии с эндокринологией и профпатологией ФПК и ППв

MD, PhD, Professor

larut@list.ruСорокинМаксим ЮрьевичSorokinMaxim

Врач-эндокринолог ГБУЗ НСО «Городская клиническая больница №1» г. Новосибирска

MD

biokvant@bk.ru<p>ФГБОУ ВО Новосибирский государственный медицинский университет Минздрава России</p>Россия<p>Novosibirsk state medical university</p>Russian Federation<p>ГБУЗ НСО Городская клиническая больница №1</p>Россия<p>City Clinical Hospital No1</p>Russian Federation201720062017202142150Copyright &#x00A9; Руяткина Л.А., Сорокин М.Ю., 20172017Руяткина Л.А., Сорокин М.Ю.Ruyatkina L.A., Sorokin 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/8296

В качестве одного из важных стратегических направлений комбинированной сахароснижающей терапии в последние годы рассматривается совместное применение аналогов базального инсулина и глюкагонподобного пептида-1 (ГПП-1). Подобная комбинация становится центральной в алгоритмах лечения сахарного диабета 2 типа (СД2) как на старте инсулинотерапии, так и в качестве альтернативы базис-болюсной инсулинотерапии. Принципиально важно, что комбинация детемира и лираглутида контролирует большинство звеньев многокомпонентного патогенеза СД2, что позволяет снижать уровни как глюкозы натощак, так и постпрандиальной гликемии при низком риске гипогликемии и отсутствии негативного влияния на массу тела. В обзоре литературы доказательно анализируются профили безопасности препаратов, а также основания для индивидуализированного выбора детемира и лираглутида с учетом потенциальных преимуществ при сопутствующих состояниях: диабетической нефропатии, высоком сердечно-сосудистом риске, что подтверждено результатами рандомизированных клинических исследований (РКИ) и данными анализа национальных регистров. Клиническая эффективность подобной комбинации оценена по данным РКИ при различном старте терапии, как с детемира, так и лираглутида. Имея разный механизм действия, сочетание базального аналога инсулина детемира и аналога ГПП-1 лираглутида обеспечивает их аддитивный сахароснижающий эффект без взаимного влияния на фармакодинамический и фармакокинетический профили.

Combined glucose-lowering therapy, comprising of basal insulin with glucagon-like peptide-1 (GLP-1) analogues, has become central to the treatment of type 2 diabetes both at the start of insulin therapy, and as an alternative to basal-bolus insulin. The combination of insulin detemir (insulin analogue) with liraglutide (GLP-1 analogue) reduces fasting and postprandial glycaemia, lowers the risk of hypoglycaemia and does not have a negative impact on body weight. In this literature review, the pharmacodynamic and pharmacokinetic profiles, as well as the potential benefits of combined insulin detemir and liraglutide therapy on diabetic nephropathy and high cardiovascular disease risk were determined. Data from randomised clinical trials and the National Registry were used to assess the clinical efficacy of combined insulin detemir and liraglutide therapy. The different mechanistic actions of insulin detemir and liraglutide resulted in an additive glucose-lowering effect, which did not affect the pharmacodynamic and pharmacokinetic profiles of each therapeutic agent.

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