Ожирение у больных сахарным диабетом 1 типа: причины и следствия

Ожирение у больных сахарным диабетом 1 типа (СД1) становится все более важной проблемой диабетологии. По данным разных исследований, распространенность избыточной массы тела и ожирения среди пациентов с СД1 варьирует от 15 до 50%. Около четверти больных СД1 имеют метаболический синдром. С одной стороны, увеличение массы тела у пациентов с СД1 отражает общепопуляционный тренд. С другой стороны, увеличению массы тела способствуют факторы, специфичные для диабета, такие как базис-болюсная инсулинотерапия, хроническая передозировка инсулина, гипогликемии, а также психологические проблемы, связанные с заболеванием. Связь СД1 и ожирения может быть двунаправленной. Установлено, что избыточная масса тела и ожирение повышают риск развития СД1, вероятно, способствуя аутоиммунной деструкции бета-клеток. Лица с избыточной массой тела и ожирением, по сравнению с больными с нормальной массой тела, чаще имеют инсулинорезистентность, дислипидемию и нуждаются в более высоких дозах инсулина для достижения целевых параметров гликемического контроля. Ожирение у лиц с СД1 является фактором риска диабетических микроангиопатий, артериальной гипертензии, хронической болезни почек, хронической сердечной недостаточности, сердечно-сосудистых событий, неалкогольной жировой болезни печени и ассоциировано с повышенной смертностью. Следовательно, поддержание нормальной массы тела следует считать важной задачей при лечении СД1. Обучение, диета с умеренным ограничением калорий и физическая активность являются основой стратегии профилактики и лечения ожирения у лиц с СД1. В качестве перспективных терапевтических опций рассматриваются агонисты глюкагон-подобного пептида-1, двойные агонисты глюкагон-подобного пептида-1 и глюкозозависимого инсулинотропного полипептида, ингибиторы глюкозо-натриевого котранспортера-2, метформин, однако данных по эффективности и безопасности применения этих лекарств при СД1 пока недостаточно. Накапливается опыт выполнения бариатрических вмешательств у лиц с СД1 и морбидным ожирением. Дальнейшие исследования необходимы для создания программ профилактики и лечения ожирения у пациентов с СД1.

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