Место фиксированной комбинации производных сульфонилмочевины и метформина в современной парадигме лечения сахарного диабета 2 типа

Эволюция лечения сахарного диабета 2 типа (СД2) способствовала формированию в мировом медицинском сообществе болезнь-модифицирующего кардио-рено-гепатоцентрического подхода. Благодаря этому фокус терапии сместился от простого снижения гликемии к комплексной органопротекции, что обусловлено растущим пониманием взаимосвязи между гипергликемией и развитием сердечно-сосудистых, почечных и печеночных осложнений. Современные клинические рекомендации подчеркивают важность сочетанного применения сахароснижающих препаратов с дополнительными органопротективными свойствами, таких как ингибиторы натрий-глюкозного котранспортера типа 2 (иНГЛТ2) и агонисты рецепторов глюкагоноподобного пептида-1 (арГПП-1). Вместе с тем отмечается, что для пациентов с низким и умеренным риском осложнений и при ограниченных ресурсах сохраняется актуальность традиционных препаратов, в первую очередь метформина и производных сульфонилмочевины (ПСМ).

В настоящем обзоре проведен анализ современных рекомендаций по лечению СД2 и подробно рассмотрены преимущества и ограничения ПСМ, а также фиксированной комбинации глибенкламида и метформина («Глюкованс®»), которая обеспечивает синергический эффект, высокую сахароснижающую активность, экономическую доступность и удобство применения, что особенно важно для пациентов с выраженной гипергликемией и низкой приверженностью к терапии. В статье обсуждаются показания к назначению фиксированной комбинации в зависимости от фенотипа СД2, проводится сравнение плюсов и минусов «старых» и «новых» препаратов, оцениваются возможности сочетания ПСМ и метформина с современными органопротективными препаратами. Препарат «Глюкованс®» остается востребованным и эффективным инструментом в арсенале врача-эндокринолога, особенно в условиях необходимости баланса между эффективностью, безопасностью и стоимостью лечения.

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