diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM9660diaendo-9660Research ArticleОбзорыReviewКогнитивные нарушения у больных сахарным диабетом 2 типа: распространенность, патогенетические механизмы, влияние противодиабетических препаратовCognitive impairment in patients with type 2 diabetes mellitus: prevalence, pathogenetic mechanisms, the effect of antidiabetic drugshttps://orcid.org/0000-0002-0795-8225ОстроумоваОльга ДмитриевнаOstroumovaOlga D.

д.м.н., профессор

MD, PhD, Professor

ostroumova.olga@mail.ruhttps://orcid.org/0000-0002-3973-7638СурковаЕлена ВикторовнаSurkovaElena V.

д.м.н., г.н.с.

MD, PhD, chief research associate

elenasurkova@mail.ruhttps://orcid.org/0000-0001-6589-7654ШихЕвгения ВалерьевнаChikhEvgenia V.

д.м.н., профессор

MD, PhD, Professor

chih@mail.ruhttps://orcid.org/0000-0002-4374-9754РеброваЕкатерина ВладиславовнаRebrovaEkaterina V.

к.м.н., доцент

MD, PhD, associate professor

katrina1987@rambler.ruБорисовМирон СергеевичBorisovMiron S.

студент

student

miron1998@mail.ru<p>Первый московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет);&nbsp;Московский государственный медико-стоматологический университет им. А.И. Евдокимова</p>Россия<p>I.M. Sechenov Sechenov First Moscow State Medical University;&nbsp;A.I. Evdokimov Moscow State Medical-Stomatological University</p>Russian Federation<p>ФГБУ Национальный медицинский исследовательский центр эндокринологии Минздрава России&nbsp;</p>Россия<p>Endocrinology Research Centre</p>Russian Federation<p>Первый московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)</p>Россия<p>I.M. Sechenov Sechenov First Moscow State Medical University</p>Russian Federation201810102018214307318Copyright &#x00A9; Остроумова О.Д., Суркова Е.В., Ших Е.В., Реброва Е.В., Борисов М.С., 20182018Остроумова О.Д., Суркова Е.В., Ших Е.В., Реброва Е.В., Борисов М.С.Ostroumova O.D., Surkova E.V., Chikh E.V., Rebrova E.V., Borisov M.S.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/9660

За последние годы накоплено большое количество данных о взаимосвязи между когнитивными нарушениями (КН), деменцией и сахарным диабетом (СД). Данная статья представляет обзор современной литературы, включающий определение когнитивных функций, современную классификацию КН, патогенетические механизмы влияния СД на развитие КН и деменции (нарушение нейрогенеза, нарушение целостности гематоэнцефалического барьера, системные воспалительные реакции, гипер- и гипогликемия, инсулинорезистентность, дисфункция сосудов микроциркуляторного русла и повышение уровня глюкокортикостероидов). Подробно рассмотрено влияние на когнитивные функции противодиабетических лекарственных средств: препаратов инсулина, пероральных сахароснижающих средств группы бигуанидов (метформин), тиазолидиндионов (розиглитазона и пиоглитазона), производных сульфонилмочевины (гликлазида, глипизида), ингибиторов α-глюкозидазы (акарбоза), инкретиннаправленной терапии (агонистов рецептора глюкагоноподобного пептида (эксенатид и лираглутид) и ингибиторов дипептидилпептидазы 4 типа (ситаглиптин, вилдаглиптин и алоглипттин), ингибиторов натриево-глюкозного котранспортера 2 типа. Приведены данные, свидетельствующие о разнонаправленном действии на когнитивные функции различных противодиабетических препаратов, проанализировано возможное влияние на скорость прогрессирования КН и риск деменции интенсивного контроля уровня глюкозы в плазме по сравнению со стандартным снижением у пациентов с СД 2 типа.

In recent years, a large amount of data has been accumulated on the relationship between cognitive impairment, dementia and diabetes mellitus. This article presents an overview of modern literature, including the definition of cognitive functions, the modern classification of cognitive impairment, pathogenetic mechanisms of diabetes mellitus influence on the development of cognitive impairment and dementia (neurogenesis, integrity of the blood-brain barrier, systemic inflammatory reactions, hyper- and hypoglycemia, insulin resistance, vascular dysfunction of the microvasculature and increase in glucocorticosteroids). The influence of anti-diabetic medications on cognitive functions has been examined in detail: insulin preparations, oral hypoglycemic agents of the biguanide group (metformin), thiazolidinediones (rosiglitazone and pioglitazone), sulfonylurea derivatives (glycazide, glipizide), a-glucosidase (acarbose) inhibitors, incretin-directed therapy (receptor agonists glucan-like peptide (exenatide and liraglutide) and inhibitors of dipeptidylpeptidase type 4 (sitagliptin, vildagliptin and alogliptin)), sodium glucose inhibitors cotransporter type 2. The data demonstrating a multidirectional effect on the cognitive functions of various antidiabetic drugs is presented, the possible influence on the rate of progression of cognitive impairment and the risk of dementia of intensive control of plasma glucose level in comparison with the standard decrease in patients with type 2 diabetes is analyzed.

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