docruДоктор.РуTitle1727-23782713-2994ООО "ГК "РУСМЕДИКАЛ"10.31550/1727-2378-2023-22-4-40-46docru-237Research ArticleКАРДИОМЕТАБОЛИЧЕСКАЯ МЕДИЦИНАCARDIOMETABOLIC MEDICINEВлияние дапаглифлозина на жировой и углеводный обмен у пациентов с сахарным диабетом 2 типаEffect of Dapagliflozin on Fat and Carbohydrate Metabolism in Patients with Type 2 Diabetes Mellitushttps://orcid.org/0000-0002-7371-6726ГоголеваC. П.GogolevaS. P.

Гоголева Сайыына Петровна — аспирант 3-го года кафедры эндокринологии 

125993, г. Москва, ул. Баррикадная, д. 2/1, стр. 1

2/1 Barrikadnaya Str., build. 1, Moscow, 125993

saina.gogoleva@inbox.ruhttps://orcid.org/0000-0002-7936-7619АметовА. С.AmetovA. S.

Аметов Александр Сергеевич — д. м. н., профессор, заведующий кафедрой эндокринологии, заведующий сетевой кафедрой ЮНЕСКО по теме «Биоэтика сахарного диабета как глобальная проблема» 

125993, г. Москва, ул. Баррикадная, д. 2/1, стр. 1

2/1 Barrikadnaya Str., build. 1, Moscow, 125993

alexander.ametov@gmail.comhttps://orcid.org/0000-0001-9604-7775ШабалинаА. А.ShabalinaA. A.

Шабалина Алла Анатольевна — д. м. н., ведущий научный сотрудник, руководитель лаборатории гемореологии, гемостаза и фармакокинетики (с клинической лабораторной диагностикой)

125367,  г. Москва, Волоколамское шоссе, д. 80, стр. 1

80 Volokolamskoye Highway, build 1, Moscow, 125367

ashabalina@yandex.ruФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationФГБНУ «Научный центр неврологии»РоссияResearch Center of NeurologyRussian Federation202318022025224КАРДИОМЕТАБОЛИЧЕСКАЯ МЕДИЦИНА4046Copyright © Гоголева C.П., Аметов А.С., Шабалина А.А., 20252025Гоголева C.П., Аметов А.С., Шабалина А.А.Gogoleva S.P., Ametov A.S., Shabalina A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://docru.elpub.ru/jour/article/view/237Цель исследования

Цель исследования: оценка эффективности дапаглифлозина в коррекции нарушений углеводного обмена и метаболизма жира при сахарном диабете 2 типа (СД2).

Дизайн

Дизайн: открытое когортное контролируемое проспективное исследование.

Материалы и методы

Материалы и методы. Обследованы 60 человек с СД2 и ожирением. К метформину им добавили дапаглифлозин в дозе 10 мг. В течение 6 месяцев оценивались параметры углеводного обмена, жировой обмен: проводились антропометрия, биоимпедансное сканирование состава тела, исследование уровней адипокинов (адипонектина, лептина, иризина, интерлейкина (ИЛ) 6) и липидограммы в динамике.

Результаты

Результаты. На фоне приема дапаглифлозина выявлена, наряду со снижением уровня гликированного гемоглобина в среднем на 0,6% (p = 0,093), значимая положительная динамика показателей жирового обмена. Масса тела пациентов в среднем снизилась на 3,3 кг (p < 0,05). Отмечалось статистически значимое уменьшение жировой массы на 3 кг (p = 0,001) и увеличение скелетно-мышечной массы, по данным биоимпедансного сканирования состава тела, что коррелировало с понижением уровня лептина (p = 0,073) и возрастанием уровней адипонектина и иризина (p < 0,05). Обнаружено и статистически значимое снижение концентраций общего холестерина, триглицеридов и липопротеинов низкой плотности (p = 0,001).

Заключение

Заключение. Уменьшение уровней лептина и ИЛ-6 в сочетании с увеличением содержания иризина и адипонектина при приеме дапаглифлозина коррелируют со снижением жировой массы и увеличением скелетно-мышечной массы, что предполагает возможность перехода из метаболически нездорового в метаболически здоровое ожирение. Коррекция дисфункции жировой ткани в качестве фокуса лечения может обеспечить не только контроль СД2, но и снижение кардиометаболических рисков у таких пациентов. 

Aim

Aim: To determine the effects of dapagliflozin in impaired carbohydrate and fat metabolism in type 2 diabetes mellitus (T2DM).

Design

Design: An open cohort controlled prospective study.

Materials and methods

Materials and methods. In this study 60 patients with T2DM and obesity were examined. Dapagliflozin 10 mg was added to metformin monotherapy. Carbohydrate metabolism and fat metabolism markers were evaluated for 6 months: anthropometry, body composition analysis, assessment of adipokines (adiponectin, leptin, irisin, interleukin (IL) 6) and lipid panel.

Results

Results. Dapagliflozin addition resulted in glycated hemoglobin level decrease by an average of 0.6% (p = 0.093) along with significant positive effects on fat metabolism markers. The mean body mass decrease was 3.3 kg (p < 0.05). There was also a significant decrease in fat mass of 3 kg (p = 0.001) and a muscle mass extension, according to a body composition analysis report, which correlated with leptin levels decrease (p = 0.073) and adiponectin and irisin levels increase (p < 0.05). A significant decrease in total cholesterol, triglycerides and low-density lipoproteins levels also occurred (p = 0.001).

Conclusion

Conclusion. Leptin and IL-6 levels decrease and irisin and adiponectin levels increase correlating with a fat mass reduction and muscle mass expansion occurred with dapagliflozin added to the therapy. These findings suggest the possibility of metabolically unhealthy obesity transitioning to metabolically healthy obesity. Adipose tissue dysfunction treatment as a focus of therapy may provide not only a better control of T2DM, but also cardiometabolic risks reduction

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The authors declare that there are no conflicts of interest present.