diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM8726diaendo-8726Research ArticleДиагностика, контроль, лечениеDiagnosis, control, treatmentОжирение и сахарный диабет 2 типа: поиск компромиссного терапевтического решенияObesity and type 2 diabetes: can we find a compromised treatment solution?https://orcid.org/0000-0001-6581-4521ГалстянГагик РадиковичGalstyanGagik R.

д.м.н., профессор, заведующий отделением диабетической стопы

MD, PhD, Professor

galstyangagik964@gmail.comhttps://orcid.org/0000-0001-6612-6851ШестаковаЕкатерина АлексеевнаShestakovaEkaterina A.

к.м.н., ведущий научный сотрудник

MD, PhD

katiashestakova@mail.ruhttps://orcid.org/0000-0002-7768-4717СкляникИгорь АлександровичSklyanikIgor A.

аспирант

MD, PhD student

sklyanik.igor@gmail.com<p>ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава России</p>Россия<p>Endocrinology Research Centre</p>Russian Federation<p>ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава России;&nbsp;Московский государственный университет им. М.В. Ломоносова</p>Россия<p>Endocrinology Research Centre; Lomonosov Moscow State University</p>Russian Federation<p>ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава России;&nbsp;Московский государственный университет им. М.В. Ломоносова</p>Россия<p>Endocrinology Research Centre;&nbsp;Lomonosov Moscow State University</p> <p>&nbsp;</p>Russian Federation201725102017204270278Copyright &#x00A9; Галстян Г.Р., Шестакова Е.А., Скляник И.А., 20172017Галстян Г.Р., Шестакова Е.А., Скляник И.А.Galstyan G.R., Shestakova E.A., Sklyanik I.A.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/8726

Ожирение и сахарный диабет 2 типа (СД2) являются эпидемиями 21 века. Ожирение является одним из главных факторов риска развития СД2, поэтому часто можно диагностировать оба заболевания у одного пациента. Наличие у пациента обоих заболеваний создает трудности как для нормализации углеводного обмена, так и для достижения нормальной массы тела. Многие сахароснижающие препараты приводят к увеличению массы тела, что, в свою очередь, способствует нарастанию инсулинорезистентности и требует дальнейшей интенсификации сахароснижающей терапии.

В практической деятельности важно при назначении терапии найти баланс между оптимальной сахароснижающей активностью препарата и благоприятным профилем безопасности в отношении массы тела. В последние десятилетия появились новые классы препаратов для лечения СД2, не влияющие на массу тела или даже снижающие ее. Также арсенал терапии для лечения ожирения пополнился лекарственными средствами, сочетающими способность снижать массу тела и компенсировать углеводный обмен. В обзоре представлены данные о современной терапии ожирения и СД2 и варианты оптимальных терапевтических комбинаций.

Type 2 diabetes and obesity are two enormous epidemic diseases of the 21st century. Because obesity is a primary risk factor for type 2 diabetes development, patients with diabetes are frequently obese. This comorbidity makes it challenging for these patients to not only compensate diabetes but also bring their weight back to normal. Several anti-diabetic drugs cause weight gain, which augments insulin resistance, and thus demands anti-diabetic treatment intensification. For the treatment, it is crucial to find an anti-diabetic treatment drug that is efficient but does not cause weight gain. In the last few decades, new anti-diabetic drugs with minimal or decrementing effects on the body weight have been introduced. New molecules appearing in the anti-obesity treatment are capable of not only reducing weight but also compensating diabetes. This study focuses on the current anti-obesity and anti-diabetic treatment and optimal combinations for treating comorbid patients.

сахарный диабет 2 типаожирениесахароснижающая терапияпрепараты для лечения ожиренияtype 2 diabetes mellitusobesityantidiabetic drugsantiobesity drugsРоссийский научный фонд (проект №17-15-01435)Russian Science Foundation grant №17-15-01435ReferencesIDF Diabetes Atlas, issue 2015, available at: www.diabetesatlas.org.IDF Diabetes Atlas, issue 2015, available at: www.diabetesatlas.org.Standards of Medical Care in Diabetes—2016. Obesity Management for the Treatment of Type 2 Diabetes. Diabetes Care. 2016;39(S1): S47-S51. doi: 10.2337/dc16-S009Standards of Medical Care in Diabetes—2016. Obesity Management for the Treatment of Type 2 Diabetes. Diabetes Care. 2016;39(S1): S47-S51. doi: 10.2337/dc16-S009Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–1486. doi: 10.2337/dc10-2415Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–1486. doi: 10.2337/dc10-2415Mitri J, Hamdy O. Diabetes medications and body weight. Expert Opin Drug Saf. 2009;8(5):573–584. doi: 10.1517/14740330903081725Mitri J, Hamdy O. Diabetes medications and body weight. Expert Opin Drug Saf. 2009;8(5):573–584. doi: 10.1517/14740330903081725The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–154. doi: 10.1056/NEJMoa1212914The Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–154. doi: 10.1056/NEJMoa1212914Lau DC, Teoh H. Impact of Current and Emerging Glucose-Lowering Drugs on Body Weight in Type 2 Diabetes. Can J Diabetes. 2015;39(5): S148–S154. doi: 10.1016/j.jcjd.2015.09.090Lau DC, Teoh H. Impact of Current and Emerging Glucose-Lowering Drugs on Body Weight in Type 2 Diabetes. Can J Diabetes. 2015;39(5): S148–S154. doi: 10.1016/j.jcjd.2015.09.090Pi-Sunyer F. Weight loss in type 2 diabetic patients. Diabetes Care. 2005;28(6):1526–1527. doi: 10.2337/diacare.28.6.1526Pi-Sunyer F. Weight loss in type 2 diabetic patients. Diabetes Care. 2005;28(6):1526–1527. doi: 10.2337/diacare.28.6.1526UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet. 1998;352(9131):837–853. doi: 10.1016/S0140-6736(98)07019-6UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). The Lancet. 1998;352(9131):837–853. doi: 10.1016/S0140-6736(98)07019-6Knowler WC, Barrett-Connor E, Fowler, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. doi: 10.1056/NEJMoa012512Knowler WC, Barrett-Connor E, Fowler, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. doi: 10.1056/NEJMoa012512Lindström J, Louheranta A, Mannelin M, et al. Finnish Diabetes Prevention Study Group. The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26(12):3230–3236. doi: 10.2337/diacare.26.12.3230Lindström J, Louheranta A, Mannelin M, et al. Finnish Diabetes Prevention Study Group. The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26(12):3230–3236. doi: 10.2337/diacare.26.12.3230The Diabetes Prevention Program (DPP) research group. The Diabetes Prevention Program (DPP). Description of lifestyle intervention. Diabetes Care. 2002;25(12):2165-2171. doi: 10.2337/diacare.25.12.2165The Diabetes Prevention Program (DPP) research group. The Diabetes Prevention Program (DPP). Description of lifestyle intervention. Diabetes Care. 2002;25(12):2165-2171. doi: 10.2337/diacare.25.12.2165Moyer V. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Annals of internal medicine. 2012;157(5):373–378. doi: 10.7326/0003-4819-157-5-201209040-00475Moyer V. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Annals of internal medicine. 2012;157(5):373–378. doi: 10.7326/0003-4819-157-5-201209040-00475Carvajal R, Wadden TA, Tsai AG, et al. Managing obesity in primary care practice: a narrative review. Annals of the New York Academy of Sciences. 2013;1281(1):191–206. doi: 10.1111/nyas.12004Carvajal R, Wadden TA, Tsai AG, et al. Managing obesity in primary care practice: a narrative review. Annals of the New York Academy of Sciences. 2013;1281(1):191–206. doi: 10.1111/nyas.12004Wing RR, Lang W, Wadden TA et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–1486. doi: 10.2337/dc10-2415Wing RR, Lang W, Wadden TA et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34(7):1481–1486. doi: 10.2337/dc10-2415Wadden TA, Volger S, Tsai AG, et al. Managing obesity in primary care practice: an overview with perspective from the POWER-UP study. International journal of obesity. 2013; 37(Suppl 1):S3–S11. doi: 10.1038/ijo.2013.90Wadden TA, Volger S, Tsai AG, et al. Managing obesity in primary care practice: an overview with perspective from the POWER-UP study. International journal of obesity. 2013; 37(Suppl 1):S3–S11. doi: 10.1038/ijo.2013.90Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011;54(10): 2506–2514. doi: 10.1007/s00125-011-2204-7Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011;54(10): 2506–2514. doi: 10.1007/s00125-011-2204-7Steven S, Hollingsworth K, Al-Mrabeh A, et al. Very-Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiologic Changes in Responders and Nonresponders. Diabetes Care. 2016;39(5):808-815. doi: 10.2337/dc15-1942Steven S, Hollingsworth K, Al-Mrabeh A, et al. Very-Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiologic Changes in Responders and Nonresponders. Diabetes Care. 2016;39(5):808-815. doi: 10.2337/dc15-1942The Look AHEAD Research Group. Eight-Year Weight Losses with an Intensive Lifestyle Intervention: The Look AHEAD Study. Obesity. 2014; 22(1): 5–13. doi: 10.1002/oby.20662The Look AHEAD Research Group. Eight-Year Weight Losses with an Intensive Lifestyle Intervention: The Look AHEAD Study. Obesity. 2014; 22(1): 5–13. doi: 10.1002/oby.20662Rothberg AE, McEwen LN, Kraftson AT, et al. Very-low-energy diet for type 2 diabetes: an underutilized therapy? J Diabetes Complications. 2014;28(4):506–510. doi: 10.1016/j.jdiacomp.2014.03.014Rothberg AE, McEwen LN, Kraftson AT, et al. Very-low-energy diet for type 2 diabetes: an underutilized therapy? J Diabetes Complications. 2014;28(4):506–510. doi: 10.1016/j.jdiacomp.2014.03.014Schwartz S, Herman M. Revisiting weight reduction and management in the diabetic patient: Novel therapies provide new strategies. Postgrad Med. 2015;127(5):480–493. doi: 10.1080/00325481.2015.1043182Schwartz S, Herman M. Revisiting weight reduction and management in the diabetic patient: Novel therapies provide new strategies. Postgrad Med. 2015;127(5):480–493. doi: 10.1080/00325481.2015.1043182Holman RR, Farmer AJ, Davies MJ, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361(18):1736–1747. doi: 10.1056/NEJMoa0905479Holman RR, Farmer AJ, Davies MJ, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361(18):1736–1747. doi: 10.1056/NEJMoa0905479Domecq JP, Prutsky G, Leppin A, et al. Drugs commonly associated with weight change: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100(2):363–370. doi: 10.1210/jc.2014-3421Domecq JP, Prutsky G, Leppin A, et al. Drugs commonly associated with weight change: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100(2):363–370. doi: 10.1210/jc.2014-3421Kahn SE, Haffner SM, Heise MA, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med. 2006;355(23):2427–2443. doi: 10.1056/NEJMoa066224Kahn SE, Haffner SM, Heise MA, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med. 2006;355(23):2427–2443. doi: 10.1056/NEJMoa066224Buse JB, DeFronzo RA, Rosenstock J, et al. The Primary Glucose-Lowering Effect of Metformin Resides in the Gut, Not the Circulation: Results From Short-term Pharmacokinetic and 12-Week Dose-Ranging Studies. Diabetes Care. 2016;39(2):198–205. doi: 10.2337/dc15-0488Buse JB, DeFronzo RA, Rosenstock J, et al. The Primary Glucose-Lowering Effect of Metformin Resides in the Gut, Not the Circulation: Results From Short-term Pharmacokinetic and 12-Week Dose-Ranging Studies. Diabetes Care. 2016;39(2):198–205. doi: 10.2337/dc15-0488Salpeter SR, Buckley NS, Kahn JA, et al. Meta-analysis: Metformin treatment in persons at risk for diabetes mellitus. Am J Med. 2008;121(12):149–157.e2. doi: 10.1016/j.amjmed.2007.09.016Salpeter SR, Buckley NS, Kahn JA, et al. Meta-analysis: Metformin treatment in persons at risk for diabetes mellitus. Am J Med. 2008;121(12):149–157.e2. doi: 10.1016/j.amjmed.2007.09.016Esquivel MA, Lansang MC. Optimizing diabetes treatment in the presence of obesity. Cleve Clin J Med. 2017;84(7 Suppl 1):S22-S29. doi: 10.3949/ccjm.84.s1.04Esquivel MA, Lansang MC. Optimizing diabetes treatment in the presence of obesity. Cleve Clin J Med. 2017;84(7 Suppl 1):S22-S29. doi: 10.3949/ccjm.84.s1.04Holman RR, Cull CA, Turner RC. A randomized double-blind trial of acarbose in type 2 diabetes shows improved glycemic control over 3 years (U.K. Prospective Diabetes Study 44). Diabetes Care. 1999;22(6):960–964. doi: 10.2337/diacare.22.6.960Holman RR, Cull CA, Turner RC. A randomized double-blind trial of acarbose in type 2 diabetes shows improved glycemic control over 3 years (U.K. Prospective Diabetes Study 44). Diabetes Care. 1999;22(6):960–964. doi: 10.2337/diacare.22.6.960Foley JE, Jordan J. Weight neutrality with the DPP-4 inhibitor, vildagliptin: Mechanistic basis and clinical experience. Vasc Health Risk Manag. 2010;9(6):541–548. doi: 10.2147/VHRM.S10952Foley JE, Jordan J. Weight neutrality with the DPP-4 inhibitor, vildagliptin: Mechanistic basis and clinical experience. Vasc Health Risk Manag. 2010;9(6):541–548. doi: 10.2147/VHRM.S10952Matthews DR, Dejager S, Ahren B, et al. Vildagliptin add-on to metformin produces similar efficacy and reduced hypoglycaemic risk compared with glimepiride, with no weight gain: results from a 2-year study. Diabetes Obes Metab. 2010;12(9):780–789. doi: 10.1111/j.1463-1326.2010.01233.xMatthews DR, Dejager S, Ahren B, et al. Vildagliptin add-on to metformin produces similar efficacy and reduced hypoglycaemic risk compared with glimepiride, with no weight gain: results from a 2-year study. Diabetes Obes Metab. 2010;12(9):780–789. doi: 10.1111/j.1463-1326.2010.01233.xFerrannini E, Fonseca V, Zinman B, et al. Fifty-two-week efficacy and safety of vildagliptin versus glimepiride in patients with type 2 diabetes mellitus inadequately controlled on metformin monotherapy. Diabetes, Obesity and Metabolism. 2009;11(2);157–166. doi: 10.1111/j.1463-1326.2008.00994.xFerrannini E, Fonseca V, Zinman B, et al. Fifty-two-week efficacy and safety of vildagliptin versus glimepiride in patients with type 2 diabetes mellitus inadequately controlled on metformin monotherapy. Diabetes, Obesity and Metabolism. 2009;11(2);157–166. doi: 10.1111/j.1463-1326.2008.00994.xШестакова М.В., Сухарева О.Ю., Чернова Т.О., и др. Комбинация ингибитора дипептидилпептидазы-4 и метформина в лечении больных сахарным диабетом 2-го типа: эффективный контроль гликемии, массы и количественного состава тела // Терапевтический архив. – 2013. – Т. 85. – №8. – С. 49-55. [Shestakova MV, Sukhareva OIu, Chernova TO, et al. A combination of dipeptidyl peptidase-4 inhibitor and metformin in the treatment of patients with type 2 diabetes mellitus: effective control of glycemia, weight, and quantitative body composition. Ter Arkh. 2013;85(8):49-55. (in Russ.)]Шестакова М.В., Сухарева О.Ю., Чернова Т.О., и др. Комбинация ингибитора дипептидилпептидазы-4 и метформина в лечении больных сахарным диабетом 2-го типа: эффективный контроль гликемии, массы и количественного состава тела // Терапевтический архив. – 2013. – Т. 85. – №8. – С. 49-55. [Shestakova MV, Sukhareva OIu, Chernova TO, et al. A combination of dipeptidyl peptidase-4 inhibitor and metformin in the treatment of patients with type 2 diabetes mellitus: effective control of glycemia, weight, and quantitative body composition. Ter Arkh. 2013;85(8):49-55. (in Russ.)]Ahrén B, Foley JE. Improved glucose regulation in type 2 diabetic patients with DPP-4 inhibitors: focus on alpha and beta cell function and lipid metabolism. Diabetologia. 2016;59(5):907-917. doi: 10.1007/s00125-016-3899-2.Ahrén B, Foley JE. Improved glucose regulation in type 2 diabetic patients with DPP-4 inhibitors: focus on alpha and beta cell function and lipid metabolism. Diabetologia. 2016;59(5):907-917. doi: 10.1007/s00125-016-3899-2.Matikainen N, Mänttäri S, Schweizer A, et al. Vildagliptin therapy reduces postprandial intestinal triglyceride-rich lipoprotein particles in patients with type 2 diabetes. Diabetologia. 2006;49(9):2049–2057. doi: 10.1007/s00125-006-0340-2Matikainen N, Mänttäri S, Schweizer A, et al. Vildagliptin therapy reduces postprandial intestinal triglyceride-rich lipoprotein particles in patients with type 2 diabetes. Diabetologia. 2006;49(9):2049–2057. doi: 10.1007/s00125-006-0340-2Boschmann M, Engeli S, Dobberstein K, et al. Dipeptidyl-peptidase-IV inhibition augments postprandial lipid mobilization and oxidation in type 2 diabetic patients. J Clin Endocrinol Metab. 2009;94(3):846–852. doi: 10.1210/jc.2008-1400Boschmann M, Engeli S, Dobberstein K, et al. Dipeptidyl-peptidase-IV inhibition augments postprandial lipid mobilization and oxidation in type 2 diabetic patients. J Clin Endocrinol Metab. 2009;94(3):846–852. doi: 10.1210/jc.2008-1400Vilsboll T, Christensen M, Junker AE, et al. Effects of glucagon-like peptide-1 receptor agonists on weight loss: Systematic review and meta-analyses of randomized controlled trials. BMJ. 2012;334(10):d7771. doi: 10.1136/bmj.d7771. doi: 10.1136/bmj.d7771Vilsboll T, Christensen M, Junker AE, et al. Effects of glucagon-like peptide-1 receptor agonists on weight loss: Systematic review and meta-analyses of randomized controlled trials. BMJ. 2012;334(10):d7771. doi: 10.1136/bmj.d7771. doi: 10.1136/bmj.d7771Garber A, Henry R, Ratner R, et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): A randomised, 52-week, phase III, doubleblind, parallel-treatment trial. Lancet. 2009;373(9662):473–481. doi: 10.1016/S0140-6736(08)61246-5Garber A, Henry R, Ratner R, et al. Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): A randomised, 52-week, phase III, doubleblind, parallel-treatment trial. Lancet. 2009;373(9662):473–481. doi: 10.1016/S0140-6736(08)61246-5Davies MJ, Bergenstal R, Bode B, et al. Efficacy of Liraglutide for Weight Loss Among Patients With Type 2 Diabetes. The SCALE Diabetes Randomized Clinical Trial. JAMA. 2015;314(7):687-699. doi: 10.1001/jama.2015.9676Davies MJ, Bergenstal R, Bode B, et al. Efficacy of Liraglutide for Weight Loss Among Patients With Type 2 Diabetes. The SCALE Diabetes Randomized Clinical Trial. JAMA. 2015;314(7):687-699. doi: 10.1001/jama.2015.9676Valsamakis G, Konstantakou P, Mastorakos G. New targets for drug treatment of obesity. Annu Rev Pharmacol Toxicokl. 2017;57(1):585–605. doi: 10.1146/annurev-pharmtox-010716-104735Valsamakis G, Konstantakou P, Mastorakos G. New targets for drug treatment of obesity. Annu Rev Pharmacol Toxicokl. 2017;57(1):585–605. doi: 10.1146/annurev-pharmtox-010716-104735Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311-322. doi: 10.1056/NEJMoa1603827Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311-322. doi: 10.1056/NEJMoa1603827Hasan FM, Alsahli M, Gerich JE. SGLT2 inhibitors in the treatment of type 2 diabetes. Diabetes Res Clin Pract. 2014;104(3):297–322. doi: 10.1016/j.diabres.2014.02.014Hasan FM, Alsahli M, Gerich JE. SGLT2 inhibitors in the treatment of type 2 diabetes. Diabetes Res Clin Pract. 2014;104(3):297–322. doi: 10.1016/j.diabres.2014.02.014Yang X-P, Lai D, Zhong X-Y, et al. Efficacy and safety of canagliflozin in subjects with type 2 diabetes: Systematic review and meta-analysis. Eur J Clin Pharmacol. 2014;70(10):1149–1158. doi: 10.1007/s00228-014-1730-xYang X-P, Lai D, Zhong X-Y, et al. Efficacy and safety of canagliflozin in subjects with type 2 diabetes: Systematic review and meta-analysis. Eur J Clin Pharmacol. 2014;70(10):1149–1158. doi: 10.1007/s00228-014-1730-xScheen A. Pharmacodynamics, Efficacy and safety of sodium–glucose co-transporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus. Drugs. 2015;75(1):33–59. doi: 10.1007/s40265-014-0337-yScheen A. Pharmacodynamics, Efficacy and safety of sodium–glucose co-transporter type 2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus. Drugs. 2015;75(1):33–59. doi: 10.1007/s40265-014-0337-yVasilakou D, Karagiannis T, Athanasiadou E, et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: A systematic review and meta-analysis. Ann Intern Med. 2013;159(4):262–274. doi: 10.7326/0003-4819-159-4-201308200-00007Vasilakou D, Karagiannis T, Athanasiadou E, et al. Sodium-glucose cotransporter 2 inhibitors for type 2 diabetes: A systematic review and meta-analysis. Ann Intern Med. 2013;159(4):262–274. doi: 10.7326/0003-4819-159-4-201308200-00007Garber A, Abrahamson M, Barzilay J, et al. Consensus statement by the american association of clinical endocrinologists and american college of endocrinology on the comprehensive type 2 diabetes management algorithm – 2016 executive summary. Endocr Pract. 2016;22(1):84-113. doi: 10.4158/EP151126.CSGarber A, Abrahamson M, Barzilay J, et al. Consensus statement by the american association of clinical endocrinologists and american college of endocrinology on the comprehensive type 2 diabetes management algorithm – 2016 executive summary. Endocr Pract. 2016;22(1):84-113. doi: 10.4158/EP151126.CSZinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Eng J Med. 2015;373(22):2117–2128. doi: 10.1056/NEJMoa1504720Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Eng J Med. 2015;373(22):2117–2128. doi: 10.1056/NEJMoa1504720Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi: 10.1056/NEJMoa1611925.Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(7):644-657. doi: 10.1056/NEJMoa1611925.Дедов И.И., Шестакова М.В., Аметов А.С., и др. Инициация и интенсификация сахароснижающей терапии у больных сахарным диабетом 2 типа: обновление консенсуса совета экспертов Российской ассоциации эндокринологов (2015) // Сахарный диабет. – 2015. – Т. 18. – №1. – C. 5-23. [Dedov II, Shestakova MV, Ametov AS, Antsiferov MB, Galstyan GR, Mayorov AY, et al. Initiation and intensification of antihyperglycemic therapy in type 2 diabetes mellitus: Update of Russian Association of Endocrinologists expert consensus document (2015). Diabetes mellitus. 2015;18(1):5-23. (in Russ.)] doi: 10.14341/DM201515-23Дедов И.И., Шестакова М.В., Аметов А.С., и др. Инициация и интенсификация сахароснижающей терапии у больных сахарным диабетом 2 типа: обновление консенсуса совета экспертов Российской ассоциации эндокринологов (2015) // Сахарный диабет. – 2015. – Т. 18. – №1. – C. 5-23. [Dedov II, Shestakova MV, Ametov AS, Antsiferov MB, Galstyan GR, Mayorov AY, et al. Initiation and intensification of antihyperglycemic therapy in type 2 diabetes mellitus: Update of Russian Association of Endocrinologists expert consensus document (2015). Diabetes mellitus. 2015;18(1):5-23. (in Russ.)] doi: 10.14341/DM201515-23Middleton KM, Patidar SM, Perri MG. The impact of extended care on the long-term maintenance of weight loss: a systematic review and meta-analysis. Obesity reviews. 2012;13(6):509–517. doi: 10.1111/j.1467-789X.2011.00972.xMiddleton KM, Patidar SM, Perri MG. The impact of extended care on the long-term maintenance of weight loss: a systematic review and meta-analysis. Obesity reviews. 2012;13(6):509–517. doi: 10.1111/j.1467-789X.2011.00972.xDrucker DJ. Incretin-based therapy and the quest for sustained improvements in beta-cell health. Diabetes Care. 2011;34(9):2133–2135. doi: 10.2337/dc11-0986Drucker DJ. Incretin-based therapy and the quest for sustained improvements in beta-cell health. Diabetes Care. 2011;34(9):2133–2135. doi: 10.2337/dc11-0986Kahan S, Ferguson C, David S, Divine L. Obesity drug outcome measures: Results of a multistakeholder critical dialoque. Current Obesity Reports. 2013;2(2):128–133. doi: 10.1007/s13679-013-0052-0Kahan S, Ferguson C, David S, Divine L. Obesity drug outcome measures: Results of a multistakeholder critical dialoque. Current Obesity Reports. 2013;2(2):128–133. doi: 10.1007/s13679-013-0052-0Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE comprehensive diabetes management algorithm 2013. Endocrine practice. 2013; 19(2):327–336. doi: 10.4158/endp.19.2.a38267720403k242Garber AJ, Abrahamson MJ, Barzilay JI, et al. AACE comprehensive diabetes management algorithm 2013. Endocrine practice. 2013; 19(2):327–336. doi: 10.4158/endp.19.2.a38267720403k242Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–362. doi: 10.1210/jc.2014-3415Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2015;100(2):342–362. doi: 10.1210/jc.2014-3415Colman E, Golden J, Roberts M, et al. The FDA's assessment of two drugs for chronic weight management. The New England journal of medicine. 2012;367(17):1577–1579. doi: 10.1056/NEJMp1211277Colman E, Golden J, Roberts M, et al. The FDA's assessment of two drugs for chronic weight management. The New England journal of medicine. 2012;367(17):1577–1579. doi: 10.1056/NEJMp1211277Rissanen A, Lean M, Rossner S, et al. Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. Int J Obes Relat Metab Disord. 2003;27(1):103–109. doi: 10.1038/sj.ijo.0802165Rissanen A, Lean M, Rossner S, et al. Predictive value of early weight loss in obesity management with orlistat: an evidence-based assessment of prescribing guidelines. Int J Obes Relat Metab Disord. 2003;27(1):103–109. doi: 10.1038/sj.ijo.0802165Finer N, Ryan DH, Renz CL, Hewkin AC. Prediction of response to sibutramine therapy in obese non-diabetic and diabetic patients. Diabetes, obesity & metabolism. 2006;8(2):206–213. doi: 10.1111/j.1463-1326.2005.00481.xFiner N, Ryan DH, Renz CL, Hewkin AC. Prediction of response to sibutramine therapy in obese non-diabetic and diabetic patients. Diabetes, obesity & metabolism. 2006;8(2):206–213. doi: 10.1111/j.1463-1326.2005.00481.xYanovski SZ, Yanovski JA. Long-term Drug Treatment for Obesity: A Systematic and Clinical Review. JAMA. 2014;311(1):74–86. doi: 10.1001/jama.2013.281361Yanovski SZ, Yanovski JA. Long-term Drug Treatment for Obesity: A Systematic and Clinical Review. JAMA. 2014;311(1):74–86. doi: 10.1001/jama.2013.281361Greenway FL, Caruso MK. Safety of obesity drugs. Expert Opin Drug Saf. 2005;4(6):1083–1095. doi: 10.1517/14740338.4.6.1083Greenway FL, Caruso MK. Safety of obesity drugs. Expert Opin Drug Saf. 2005;4(6):1083–1095. doi: 10.1517/14740338.4.6.1083Wadden TA, West DS, Neiberg RH, et al. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009;17(4):713–722 doi: 10.1038/oby.2008.637Wadden TA, West DS, Neiberg RH, et al. One-year weight losses in the Look AHEAD study: factors associated with success. Obesity (Silver Spring). 2009;17(4):713–722 doi: 10.1038/oby.2008.637Wadden T, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie diet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond). 2013;37(11):1443-51. doi: 10.1038/ijo.2013.120.Wadden T, Hollander P, Klein S, et al. Weight maintenance and additional weight loss with liraglutide after low-calorie diet-induced weight loss: the SCALE Maintenance randomized study. Int J Obes (Lond). 2013;37(11):1443-51. doi: 10.1038/ijo.2013.120.

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