Патогенетическое обоснование и эффективность применениявилдаглиптина у больных сахарным диабетом 2 типа

Инсулинорезистентность на уровне мышечной ткани и печени в сочетании с функциональной недостаточностью В-клеток поджелудочной железы представляет собой основу патогенеза сахарного диабета 2 типа (СД2). Как у становлено в настоящее время, нарушения функции β-клеток являются гораздо более ранними и выраженными, чем это предполагалось сравнительно недавно. Следовательно, для достижения более оптимального управления диабетом, профилактики либо замедления прогрессирующей функциональной недостаточности β-клеток, определяющейся уже на стадии нарушения толерантности к глюкозе, необходима новая, более ранняя и агрессивная тактика терапии. Одним из возможных подходов является терапия, основанная на воспроизведении эффектов инкретиномиметика глюкагоноподобного пептида-1 (ГПП-1). В условиях гипергликемии ГПП-1 усиливает секрецию инсулина, подавляет продукцию глюкагона, улучшает функцию β-кле-ток и замедляет перистальтику желудка. У больных СД2 содержание ГПП-1 снижено. Кроме того, ГПП-1 быстро распадается под воздействием фермента дипептидилпептидазы-4 (ДПП-4). Резуль таты исследований показали, что новый ингибитор ДПП-4 вилдаглиптин существенно снижает показатели НЬА1с, уровни глюкозы натощак и после еды при его использовании как в виде монотерапии, так и при комбинации с традиционными сахароснижающими препаратами. Преимуществами применения вилдаглиптина является небольшой спектр побочных эффектов, низкая частота гипогликемии, нейтральное влияние на массу тела, удобный способ применения в виде перорального однократного приема. Кроме того, вилдаглиптин способен предотвращать снижение функции β-клеток. Таким образом, может модифицировать естественное прогрессирующее течение диабета, что, тем не менее, необходимо подтвердить с помощью долгосрочных контролируемых исследований.

вилдаглиптин, инкретины, глюкагоноподобный пептид - 1, ингибитор дипептидилпептидазы - IV

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