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ВЫБОР САХАРОСНИЖАЮЩИХ ПРЕПАРАТОВ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2-ГО ТИПА ОЧЕНЬ ВЫСОКОГО СЕРДЕЧНО-СОСУДИСТОГО РИСКА (ЧАСТЬ 1)

https://doi.org/10.18705/1607-419X-2016-22-4-330-348

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Аннотация

В первой части обзора представлены особенности выбора традиционных сахароснижающих препаратов у больных сахарным диабетом 2-го типа в сочетании с сердечно-сосудистыми заболеваниями атеросклеротического генеза. Особое внимание уделено больным с хронической сердечной недостаточностью. В тактике ведения пациентов с сахарным диабетом 2-го типа очень высокого сердечно-сосудистого риска отражено большое значение определения индивидуализированного выбора целевого уровня гликированного гемоглобина, который у данной категории больных более высокий. Проведен анализ безопасности выбора сахароснижающих препаратов из групп бигуанидов, меглитинидов, ингибиторов альфа-глюкозидазы, инсулина и сульфанилмочевины. Оценка рандомизированных клинических исследований, метаанализов опубликованных исследований по безопасности сахароснижающих препаратов в отношении сердечнососудистой системы показала, что препаратами первой линии в инициации лечения больных очень высокого сердечно-сосудистого риска, как в монотерапии, так и в комбинации, в зависимости от исходного уровня гликированного гемоглобина, являются бигуаниды (метформин) — лекарственные средства, улучшающие прогноз, обеспечивающие снижение риска развития сердечно-сосудистых событий. Применение ряда препаратов инсулина ухудшает прогноз больных при наличии сердечно-сосудистых заболеваний. Безопасность в отношении кардиоваскулярных исходов доказана для инсулина гларгина. Препараты сульфонилмочевины (за исключением гликлазида), меглитиниды, ингибиторы альфа-глюкозидазы не рекомендуются для лечения больных сахарным диабетом 2-го типа очень высокого сердечно-сосудистого риска из-за наличия доказательств негативного влияния на прогноз, либо из-за отсутствия достаточных аргументов в пользу безопасности в отношении сердечно-сосудистой системы, либо результаты исследований противоречивы. Особенности выбора и назначения «новых» групп сахароснижающих препаратов будут представлены во второй части статьи.

Об авторах

Н. А. Козиолова
Пермский государственный медицинский университет имени академика Е. А. Вагнера
Россия

Козиолова Наталья Андреевна — доктор медицинских наук, профессор, заведующая кафедрой пропедевтики внутренних болезней.

Ул. Петропавловская, д. 26, Пермь, Россия, 614000. Факс: +7(342)222–71–13. E-mail: nakoziolova@mail.ru



А. И. Чернявина
Пермский государственный медицинский университет имени академика Е. А. Вагнера
Россия

Чернявина Анна Ивановна — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней № 2 



Е. А. Полянская
Пермский государственный медицинский университет имени академика Е. А. Вагнера
Россия

Полянская Елена Александровна — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней № 2 



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Для цитирования:


Козиолова Н.А., Чернявина А.И., Полянская Е.А. ВЫБОР САХАРОСНИЖАЮЩИХ ПРЕПАРАТОВ У БОЛЬНЫХ САХАРНЫМ ДИАБЕТОМ 2-ГО ТИПА ОЧЕНЬ ВЫСОКОГО СЕРДЕЧНО-СОСУДИСТОГО РИСКА (ЧАСТЬ 1). Артериальная гипертензия. 2016;22(4):330-348. https://doi.org/10.18705/1607-419X-2016-22-4-330-348

For citation:


Koziolova N.A., Chernyavina A.I., Polyanskaya E.A. SELECTION OF ANTYHYPERGLYCEMIC AGENTS IN HIGH-RISK PATIENTS WITH TYPE 2 DIABETES MELLITUS (PART 1). "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2016;22(4):330-348. (In Russ.) https://doi.org/10.18705/1607-419X-2016-22-4-330-348

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