Все ли мы знаем о возможностях метформина в лечении сахарного диабета 2 типа? Какая из его комбинаций наиболее изучена, эффективна и доступна для пациента в реальной практике врача-эндокринолога?


DOI: https://dx.doi.org/10.18565/pharmateca.2019.4.111-121

Е.В. Бирюкова, И.В. Соловьева

Московский государственный медико-стоматологический университет им. А.И. Евдокимова, Москва, Россия
Заболеваемость сахарным диабетом 2 типа (СД2) неуклонно растет во всем мире, а эффективность контроля гликемии при этом заболевании все еще недостаточна. Обсуждаются патогенетические механизмы СД2. Подчеркивается важная роль инсулинорезистентности как ключевого звена развития СД2. Детально рассматриваются молекулярные механизмы действия метформина, анализируются его гликемические и внегликемические эффекты, место препарата в современной терапии СД2.
Ключевые слова: сахарный диабет 2 типа, гиперинсулинемия, инсулинорезистентность, сахароснижающая терапия, гликированный гемоглобин, метформин, фиксированные комбинации

Литература


1. de Pablos-Velasco P., Parhofer K.G., Bradley C., et al. Current level of glycaemic control and its associated factors in patients with type 2 diabetes across Europe: data from the PANORAMA study. Clin Endocrinol (Oxf). 2014;80:47–56pmid:23194193

2. IDF. URL: http://www.diabetesatlas.org/

3. Dedov I.I., Shestakova M.V., Benedetti M.M., et al. Prevalence of Type 2 diabetes mellitus (T2DM) in the adult Russian population (NATION study). Diabet Res Clin Pract. 2016; 115:90–5.

4. Selvin E., Steffes M.W., et al. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med. 2010;362(9):800–11.

5. Kandula, N.R., Diez-Roux A.V., Chan C., et al. Association of acculturation levels and prevalence of diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2008;31:1621–28.

6. Cefalu W.T. Insulin resistance: cellular and clinical concepts. Exp Biol Med. 2001;226:13–26.

7. Johnson A.M.F., Olefsky J.M. The Origins and Drivers of Insulin Resistance. Cell. 2013;1526:673–83.

8. Samuel V.T., Shulman G.I. The pathogenesis of insulin resistance: integrating signaling pathways and substrate flux. J Clin Invest. 2016;126(1):12–22. Doi: 10.1172/JCI77812.

9. Wang Y., Rimm E.B., Stampfer M.J., et al. Comparison of abdominal adiposity and overall obesity in predicting risk of type 2 diabetes among men. Am J Clin Nutr. 2015;81:555–63.

10. Meyer C., Pimenta W., Woerle H.J., et al. Different mechanisms for impaired fasting glucose and impaired postprandial glucose tolerance in humans. Diabetes Care. 2006;29:1909–14.

11. Petersen M.C., Vatner D.F., Shulman G.I. Regulation of hepatic glucose metabolism in health and disease. Nature Reviews Endocrinology. 2017;13;572–87.

12. Ahren B., Pacini G. Islet adaptation to insulin resistance: mechanisms and implications for intervention. Diabetes Obes Metab. 2005;7:2–8. Doi:10.1111/j.1463-1326.2004.00361.x.

13. Clore J.N., Allred J., White D., Li J., Stillman J. The role of plasma fatty acid composition in endogenous glucose production in patients with type 2 diabetes mellitus. Metabolism. 2002;51:1471–77.

14. Færch K., Borch-Johnsen K., Holst J.J., Vaag A. Pathophysiology and aetiology of impaired fasting glycaemia and impaired glucose tolerance: does it matter for prevention and treatment of type 2 diabetes? Diabetologia. 2009;52:1714–23.

15. Bock G., Dalla Man C., Campioni M., et al. Pathogenesis of prediabetes: mechanisms of fasting and postprandial hyperglycemia in people with impaired fasting glucose and/or impaired glucose tolerance. Diabetes. 2006;55:3536–49.

16. Профилактика развития сахарного диабета типа 2: роль и место метформина. Эндокринология: новости, мнения, обучение. 2017;1(18):77–87.

17. Алгоритмы специализированной медицинской помощи больных сахарным диабетом / Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. 8-й вып. М., 2017.

18. Hemmingsen B., Lund S., Wetterslev J., Vaag A. Oral hypoglycaemic agents, insulin resistance and cardiovascular disease in patients with type 2 diabetes. Eur J Endocrinol. 2009;161:1–9.

19. Rotella C.M., Monami M., Mannucci E. Metformin beyond diabetes: new life for an old drug. Curr Diabetes Rev. 2006;2:307–15.

20. Kirpichnikov D., McFarlane S.I., Sowers J.R. Metformin. An Update. Ann Intern Med. 2002;137:25–33.

21. Kinaan M., Ding H., Triggle C. R. Metformin: An Old Drug for the Treatment of Diabetes but a New Drug for the Protection of the Endothelium. Med Princ Pract. 2015;24:401–15. Doi: 10.1159/000381643.

22. Wang D.S., Jonker J.W., Kato Y., et al. Involvement of organic cation transporter 1in hepatic and intestinal distribution of metformin. J Pharmacol Exp Ther. 2002;302:510–15.

23. Rena G., Hardie G.G., Pearson E.A. The mechanisms of action of metformin. Diabetologia. 2017;60(9):1577–85.

24. Rojas L.B.A., Gomes M.B. Metformin: an old but still the best treatment for type 2 diabetes. Diabetol Metab Syndr. 2013;5:6. Doi: https://doi.org/10.1186/1758-5996-5-6.

25. Markowicz-Piasecka M., Huttune M.K., Lukasz M., et al. Is Metformin a Perfect Drug? Updates in Pharmacokinetics and Pharmacodynamics. Current Pharmaceutical Design. 2017;23:1–19.

26. McCreight L.J., Bailey C.J., Pearson E.R. Metformin and the gastrointestinal tract. Diabetologia. 2006;59:426–43.

27. Preiss D., Dawed A., Welsh P., et al. Sustained influence ofmetformin therapy on circulating glucagon-like peptide-1 levels inindividuals with and without type 2 diabetes. Diabetes Obes Metab. 2017;19:356–43.

28. DeFronzo R.A., Buse J.B., Kim T., et al. Once-daily delayed-release metformin lowers plasma glucose and enhances fasting andpostprandial GLP-1 and PYY: results from two randomised trials. Diabetologia. 2016;59:1645–54.

29. Кожевников А.А., Раскина К.В., Мартынова Е.Ю., Тяхт А. Участие кишечной микробиоты в процессах метаболизма, старения и перспективы применения имеющихся данных в реальной клинической практике. РМЖ. 2017;2:98–105.

30. Li Y., Xu S., Mihaylova M.M., et al. AMPK phosphorylates and inhibits SREBP activity to attenuate hepatic steatosis and atherosclerosis in diet-induced insulin-resistant mice. Cell Metab. 2011;13:376–88.

31. El Messaoudi S., Rongen G.A., Riksen N.P. Metformin therapy in diabetes: the role of cardioprotection. Curr Atheroscler Rep. 2013;15(4):314.

32. Cameron A.R., Morrison V.L., Levin D., et al. Anti-inflammatory effects of metformin irrespective of diabetes status. Circ Res. 2016;119:652–65.

33. Nesti L., Natali A. Metformin effects on the heart and the cardiovascular system: A review of experimental and clinical data. Nutr Metab Cardiovasc Dis. 2017;27(8):657–69.

34. Foretz M., Guigas B., Bertrand L., et al. Metformin: From Mechanisms of Action to Therapies. Cell Metab. 2014;2:953–66.

35. UK Prospective Diabetes Study (UKPDS) Group Effect of intensive blood glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) Lancet. 1998;352:854–65.

36. Holden S.E., Jenkins-Jones S., Currie C.J. Association between Insulin Monotherapy versus Insulin plus Metformin and the Risk of All-Cause Mortality and Other Serious Outcomes: A Retrospective Cohort Study. PLoS One. 2016;6;11(5):e0153594. Doi: 10.1371/journal.pone.0153594.

37. Kao J., Tobis J., Mc Clelland R.L. Relation of metformin treatment to clinical events in diabetic patients undergoing percutaneous intervention. Am J Cardiol. 2004, 93: 1347–50. Doi: 10.1016/j.amjcard.2004.02.028.

38. Aguilar D., Wenyaw Chan W., Bozkurt B., et al. Metformin Use and Mortality in Ambulatory Patients With Diabetes and Heart Failure. Circulation: Heart Failure. 2011;4:53–8.

39. Zhang Z.J., Zheng Z.J., Shi R., Su Q., Jiang Q., Kip K. E. Metformin for liver cancer prevention in patients with type 2 diabetes: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97(7):2347–53.

40. Coyle C., Cafferty F.H., Vale C., et al. Metformin as an adjuvant treatment for cancer: a systematic review and meta-analysis. Ann Oncol. 2016;27(12):2184–95.

41. Sola D., Rossi L., Schianca G.P.C. Sulfonylureas and their use in clinical practice. Arch Med Sci. 2015;11(4):840–48.

42. Abrahami D., Douros A., Yin H., et al. Dipeptidyl peptidase-4 inhibitors and incidence of inflammatory bowel disease among patients with type 2 diabetes: Population based cohort study. BMJ. 2018 March 21. Doi: 10.1136/bmj.k872.

43. US Food and Drug Administration.

44. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complication in patients with type 2 diabetes. (UKPDS 33). Lancet. 1998;352:837–53.

45. Gangji A.S., Cukierman T., Gerstain H.C., et al. A systematic review and meta-analysis of hypoglycemia and cardiovas-cular events. A comparison of glyburide with other secretagogues and with insulin. Diabetes Care. 2007;30:389–94.

46. http://www.canonpharma.ru/insrtuctions/metformin180x300-5-09-17.jpg


Об авторах / Для корреспонденции


Автор для связи: Е.В. Бирюкова, д.м.н., проф., МГМСУ им. А.И. Евдокимова, Москва, Россия; e-mail: lena@obsudim.ru
Адрес: 127473, Россия, Москва, ул. Делегатская, 20, стр. 1


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