Введениенастоящее время сахарный диабет 2 типа (СД2) яв-ляется широко распространенным заболеванием, а эксперты ВОЗ рассматривают сло жившуюся ситуацию как пандемию. В 2010 г. в мире насчитыва-лось 285 млн взрослых больных сахарным диабетом (СД), а в России -3,16 млн. Учитывая динамику заболеваемо-сти и смертности за последние 10 лет, ожидается увеличе-ние заболеваемости СД в мире с 6,4% до 7,7%. При этом к 2030 г. прогнозируется увеличение числа зарегистриро-ванных больных СД до 439 млн человек в мире и до 5,81 млн человек в России [1,2]. Социальную значимость проблемы увеличивает то обстоятельство, что СД приводит к ран-ней инвалидизации и смертности в связи с фатальными сосудистыми осложнениями. Несмотря на проведение адекватной лекарственной терапии, показатели гликемиче-ского контроля (в том числе, содержание гликированного гемоглобина -HbA 1c ) у пациентов с СД зачастую не нор-мализуются, что связано с прогрессирующим нарушением функции β-клеток поджелудочной железы [3].Наряду с консервативной терапией, для лечения СД2 с сопутствующим ожирением сегодня уже используются бариатрические операции. Данное направление хирур-гии, изначальной целью которого являлось снижение массы тела у пациентов с морбидным первичным ожире-нием, начало формироваться в 50-х годах прошлого века. По мере развития бариатрической хирургии были вы-явлены положительные эффекты проводимых операций на сопутствующие ожирению заболевания, а именно, СД2, дислипидемию и артериальную гипертензию. Поло-жительное влияние операции гастрошунтирования (ГШ)
Background: Type 2 diabetes mellitus (DM2), which mainly develops from visceral obesity, is a socially significant disease. Reduction of losses from DM2 is a priority in modern medicine development. Glucagon-like peptide-1 receptor agonists (aGLP-1) present one of few groups of antidiabetic drugs that allows to reduce not only glycemia, but also weight in DM2. Taking into account predictors of response to the therapy will allow to reach trearment targets with the highest probability, maintaining a safety of treatment, to optimize recommendations for administration of aGPP-1 as much as possible.
Aims: To assess dynamics of metabolic parameters, to identify predictors of reduction in blood glucose, body weight and other metabolic parameters on aGLP-1 therapy in patients with DM2 with body mass index (BMI) 35 kg/m2.
Materials and methods: The study involved 33 patients (10 men, 23 women), who had been treated with aGLP-1, the observation period for 24 weeks was planned. 3 patients terminated the participation before the appointed time (1 due to pancreatitis development 2 due to the lack of financial opportunity to purchase the drug). So, 30 patients (10 men, 20 women) were included in the final analysis. Examination consisted of the survey, physical examination with measurement of anthropometric, clinical parameters, filling questionnaires. Data were evaluated at baseline and after 24 weeks of treatment.
Results: The study found that patients who achieved weight loss 5% initially had higher BMI (p = 0.028), lower GLP-1 (p = 0.036), had lower level of ghrelin after standard breakfast test (p = 0.022). There was trend (p = 0.071) to greater decrease in BMI in patients with restrictive type of eating behavior compared to patients who had a mixed type. More pronounced decrease in glycemia was noted in patients who had higher fasting plasma glucose level at inclusion (p = 0.001). Dynamics of HbA1c was better in patients with initially higher GLP-1 (p = 0.016) and higher levels of glycemia (p = 0.001). Also, we revealed the statistically significant decrease in triglycerides level, blood pressure by end of the treatment period.
Conclusions: Results indicate the different predictors for reduction in weight, glycemia and blood pressure on aGLP-1 therapy. In addition to the metabolic parameters, level of orexigenic and anorexigenic hormones and psycho-social characteristics of patients help to estimate an expected effect of aGLP-1 therapy. When being identifying, the predictors of weight loss and the predictors of carbohydrate metabolism compensation should be studied separately. Identification of response predictors is necessary to optimize indications for this group of drugs administration in DM2.
The article contains a review of domestic and foreign literature on the assessment of the clinical significance of inhibin B in the male factor infertility. Modern scientific evidence is given that inhibin B plays an important role in the regulation of spermatogenesis and can be an independent predictor of early violations of spermatogenesis, damage to the spermatogenic epithelium, as well as an important indicator in the identification of disorders of spermatogenesis.
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