diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM8804diaendo-8804Research ArticleДиагностика, контроль, лечениеDiagnosis, control, treatmentЭволюция агонистов рецепторов глюкагоноподобного пептида-1 в терапии сахарного диабета 2 типаEvolution of glucagon-like peptide-1 receptor agonists for the treatment of type 2 diabeteshttps://orcid.org/0000-0001-6581-4521ГалстянГагик РадиковичGalstyanGagik R.

д.м.н, профессор

MD, PhD, Professor

galstyangagik964@gmail.comКаратаеваЕвгения АнатольевнаKarataevaEvgeniya A.

Медицинский отдел, отделение эндокринологии

MD, Department of Endocrinology

karataeva_evgeniya@lilly.comhttps://orcid.org/0000-0003-2688-5997ЮдовичЕкатерина АлександровнаYudovichEkaterina A.

Медицинский отдел, отделение эндокринологии

MD, Department of Endocrinology

Yudovitch_ekaterina@lilly.com<p>ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава России</p>Россия<p class="PStextX2space" style="line-height: normal;"><span style="font-size: 12.0pt; font-family: 'Times New Roman',serif;">Endocrinology Research Centre</span></p>Russian Federation<p>OOO &laquo;Лилли Фарма&raquo;</p> <p>&nbsp;</p>Россия<p>Lilly Pharma Ltd</p>Russian Federation<p>OOO &laquo;Лилли Фарма&raquo;</p> <p>&nbsp;</p>Россия<p class="PStextX2space" style="line-height: normal;"><span style="font-size: 12.0pt; font-family: 'Times New Roman',serif;">Lilly Pharma Ltd</span></p>Russian Federation201725102017204286298Copyright &#x00A9; Галстян Г.Р., Каратаева Е.А., Юдович Е.А., 20172017Галстян Г.Р., Каратаева Е.А., Юдович Е.А.Galstyan G.R., Karataeva E.A., Yudovich E.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/8804

Агонисты рецепторов (АР) глюкагоноподобного пептида-1 (ГПП-1) представляют собой класс сахароснижающих препаратов, разрабатываемых в течение последних 15 лет. ГПП-1 – это пептид, синтезируемый в желудочно-кишечном тракте человека, который вносит значимый вклад в контроль постпрандиальной гликемии, стимулируя глюкозозависимую секрецию инсулина. При сахарном диабете 2 типа (СД2) отмечается снижение «инкретинового эффекта» за счет недостаточности секреции ГПП-1 или ответа на него, что может быть компенсировано применением АР ГПП-1. Эти препараты также оказывают другие эффекты, типичные для ГПП-1, которые включают глюкозозависимое снижение секреции глюкагона, задержку скорости опорожнения желудка, снижение потребления пищи, улучшение функции левого желудочка и снижение артериального давления. АР ГПП-1 короткого действия вводят 1 р/сут (ликсисенатид) или 2 р/сут (эксенатид); АР ГПП-1 длительного действия вводят 1 р/сут (лираглутид) или 1 р/нед (эксенатид с медленным высвобождением, дулаглутид, албиглутид). Все АР ГПП-1 значимо снижают уровень гликированного гемоглобина (HbA1c) у пациентов с СД2 и недостаточным гликемическим контролем на фоне терапии пероральными сахароснижающими препаратами (ПССП). По сравнению с другими сахароснижающими препаратами АР ГПП-1 обеспечивают лучший гликемический контроль, обладая дополнительным преимуществом в виде снижения массы тела. В рамках данного класса АР ГПП-1 длительного действия более эффективны, чем АР ГПП-1 короткого действия, характеризуясь сходным или более низким риском гипогликемии и более низкой частотой нежелательных явлений со стороны желудочно-кишечного тракта. Результаты прямых сравнительных исследований и данные обзорного метаанализа показывают, что лираглутид, вводимый 1 р/сут, является АР ГПП-1, наиболее эффективно снижающим уровень HbA1c. Дулаглутид – это единственный АР ГПП-1, вводимый 1 р/нед, который продемонстрировал не меньшую эффективность в сравнении с лираглутидом. Использование в клинической практике АР ГПП-1, вводимых 1 р/нед, предлагает пациентам дополнительные преимущества в виде меньшего количества инъекций и простых в использовании предзаполненных шприц-ручек. Несмотря на относительно недавнюю разработку АР ГПП-1, международные руководства по терапии сахарного диабета признают преимущества этого класса препаратов и рекомендуют их в качестве варианта лечения пациентов с СД2.

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1RAs) are a class of antidiabetic drugs developed over the past 15 years. GLP-1, a gastrointestinal peptide hormone that contributes to the postprandial “incretin effect”, stimulates glucose-dependent insulin secretion. The incretin effect is greatly diminished in type 2 diabetes, but can be restored by GLP-1RAs. These drugs also exert other GLP-1 effects, including reducing glucagon secretion, delaying gastric emptying, reducing food intake, improving cardiac ventricular function, and lowering blood pressure. Short-acting GLP-1RAs are administered once daily (lixisenatide) or twice daily (exenatide); long-acting GLP 1RAs are administered once daily (liraglutide) or once weekly (slow-release exenatide, dulaglutide, albiglutide). All GLP-1RAs significantly reduce glycated hemoglobin (HbA1c) in patients with type 2 diabetes whose glycemic control is inadequate with oral antidiabetic drugs. Compared with other antidiabetic medications, GLP-1RAs provide better glycemic control with the additional benefit of weight loss. Within this class, long-acting GLP-1RAs are more efficacious than short-acting GLP-1RAs, with similar or lower risk of hypoglycemia and lower incidence of gastrointestinal adverse effects. Head-to-head trials and a network meta-analysis suggest that once daily liraglutide is the most effective GLP-1RA in reducing HbA1c. Dulaglutide is the only once-weekly GLP 1RA demonstrated to be noninferior to liraglutide. The once-weekly GLP-1RAs offer additional advantages to patients, including fewer injections and easy-to-use, single-dose pen devices. Despite the relatively recent development of GLP-1RAs, international diabetes guidelines recognize the benefits of this class of drugs and recommend them as a treatment option for patients with type 2 diabetes.

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