endofocusFOCUS ЭндокринологияFOCUS. Endocrinology2713-01772713-0185ООО "Издательство "Перо"10.62751/2713-0177-2024-5-2-15endofocus-89Research ArticleСтатьиДеинтенсификация как новый тренд в терапии сахарного диабета 2 типаDe-intensification as a new trend in the treatment of type 2https://orcid.org/0000-0002-9296-4346ЯновскаяЕ. А.YanovskayaE. A.

Яновская Елена Александровна – к . м. н., ассистент кафедры терапии имени профессора Е. Н. Дормидонтова 

г. Ярославль

Elena A. Yanovskaya –  Can. Sci. (Med.) Assistant of the Department of Therapy named after Professor E. N. Dormidontov; Endocrinologist of the State Medical Institution of the Yaroslavl region "Regional Clinical Hospital "

Yaroslavl

lenayan2005@rambler.ruЯновскаяМ. Е.YanovskayaM. E.

Яновская Мария Ефимовна – к . м. н., заведующая эндокринологическим отделением 

г. Ярославль

Mariya E. Yanovskaya –  Can. Sci. (Med.) Head of the Endocrinology Department

Yaroslavl

КалетникЕ. И.KaletnikE. I.

Калетник Елена Игоревна –  клинический ординатор

г. Москва

Elena I. Kaletnik – clinical resident

Moscow

ФГБОУ ВО «Ярославский государственный медицинский университет» Минздрава РоссииFederal State Budgetary Educational Institution of Higher Education Yaroslavl State Medical University of the Ministry of Health of RussiaГНЦ РФ ФГБУ «Национальный медицинский исследовательский центр эндокринологии» Минздрава РоссииEndocrinology Research Centre202413052024523134Copyright © Яновская Е.А., Яновская М.Е., Калетник Е.И., 20242024Яновская Е.А., Яновская М.Е., Калетник Е.И.Yanovskaya E.A., Yanovskaya M.E., Kaletnik E.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://endofocus.elpub.ru/jour/article/view/89

В настоящее время в отечественной и международной клинической практике управления сахарным диабетом 2 типа все больше внимания уделяется возможностям деинтенсификации сахароснижающей терапии. И если еще недавно кандидатами на снижение интенсивности противодиабетической терапии являлись в первую очередь пожилые пациенты (с точки зрения снижения риска гипогликемий), то сегодня признается, что и многие другие пациенты могли бы получить преимущества от упрощения терапии, в первую очередь, при переводе со сложных схем инсулинотерапии на более простые режимы (например, на фиксированные комбинации арГПП-1 и базального инсулина). Как было показано, упрощение режима и сокращение числа инъекций повышают приверженность к терапии без ущерба для качества гликемического контроля.

Currently, a trend towards deintensification of sugar-lowering therapy has emerged in the domestic and international clinical practice of type 2 diabetes mellitus management. And while recently reducing the intensity of antidiabetic therapy was considered primarily for elderly patients in terms of reducing the risk of hypoglycemia, it is now recognized that many other patients could benefit especially by conversion from intensive insulin therapy regimens to simpler regimens (e. g., fixed combinations of GLP-1 RA and BI). Regimen simplification and reduced number of injections have been shown to improve adherence to therapy without compromising the quality of glycemic control. 

сахарный диабет 2 типадеинтенсификацияинсулинотерапияиГларЛиксииДегЛираtype 2 diabetes mellitusdeintensificationinsulin therapyiGlarLixiiDegLiraReferencesKim MJ, Fritschi C. Relationships between cognitive impairment and self-management in older adults with type 2 diabetes: an integrative review. Res Gerontol Nurs. 2021;14(2):104–12Kim MJ, Fritschi C. Relationships between cognitive impairment and self-management in older adults with type 2 diabetes: an integrative review. Res Gerontol Nurs. 2021;14(2):104–12Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: implications for research and practice. Am Psychol. 2016;71(7):539–551Gonzalez JS, Tanenbaum ML, Commissariat PV. Psychosocial factors in medication adherence and diabetes self-management: implications for research and practice. Am Psychol. 2016;71(7):539–551American Diabetes Association Professional Practice Committee; 13. Older Adults: Standards of Care in Diabetes-2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S244–S257. https://doi.org/10.2337/dc24-S013American Diabetes Association Professional Practice Committee; 13. Older Adults: Standards of Care in Diabetes-2024. Diabetes Care 1 January 2024; 47 (Supplement_1): S244–S257. https://doi.org/10.2337/dc24-S013Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016; 10:1299–1307Polonsky WH, Henry RR. Poor medication adherence in type 2 diabetes: recognizing the scope of the problem and its key contributors. Patient Prefer Adherence. 2016; 10:1299–1307Holman RR, et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med. 2007;357(17):1716–1730Holman RR, et al. Addition of biphasic, prandial, or basal insulin to oral therapy in type 2 diabetes. N Engl J Med. 2007;357(17):1716–1730Munshi MN, et al. Simplification of insulin regimen in older adults and risk of hypoglycemia. JAMA Intern Med. 2016;176(7):1023–1025Munshi MN, et al. Simplification of insulin regimen in older adults and risk of hypoglycemia. JAMA Intern Med. 2016;176(7):1023–1025Taybani Z, et al. Simplifying complex insulin regimens while preserving good glycemic control in type 2 diabetes. Diabetes Ther. 2019;10(5):1869–1878Taybani Z, et al. Simplifying complex insulin regimens while preserving good glycemic control in type 2 diabetes. Diabetes Ther. 2019;10(5):1869–1878Oktora MP, et al. Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: a scoping review. Diabet Med. 2021;38(2): e14408Oktora MP, et al. Rates, determinants and success of implementing deprescribing in people with type 2 diabetes: a scoping review. Diabet Med. 2021;38(2): e14408Seidu S, et al. Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes. Diabetes Obes Metab. 2019;21(7):1668–1679Seidu S, et al. Deintensification in older patients with type 2 diabetes: a systematic review of approaches, rates and outcomes. Diabetes Obes Metab. 2019;21(7):1668–1679Abdelhafiz AH, Sinclair AJ. Deintensification of hypoglycaemic medications-use of a systematic review approach to highlight safety concerns in older people with type 2 diabetes. J Diabetes Complicat. 2018;32(4):444–450Abdelhafiz AH, Sinclair AJ. Deintensification of hypoglycaemic medications-use of a systematic review approach to highlight safety concerns in older people with type 2 diabetes. J Diabetes Complicat. 2018;32(4):444–450McAlister FA, Youngson E, Eurich DT. Treatment deintensification is uncommon in adults with type 2 diabetes mellitus: a retrospective cohort study. Circ Cardiovasc Qual Outcomes. 2017;10(4): e003514McAlister FA, Youngson E, Eurich DT. Treatment deintensification is uncommon in adults with type 2 diabetes mellitus: a retrospective cohort study. Circ Cardiovasc Qual Outcomes. 2017;10(4): e003514Cristina García-Ulloa A, Jaime-Casas S, Rosado-Lozoya J, et al. De-escalating treatment indications for patients who achieve metabolic goals. Diabetes Res Clin Pract. 2024; 208:111096. doi:10.1016/j.diabres.2024.111096Cristina García-Ulloa A, Jaime-Casas S, Rosado-Lozoya J, et al. De-escalating treatment indications for patients who achieve metabolic goals. Diabetes Res Clin Pract. 2024; 208:111096. doi:10.1016/j.diabres.2024.111096Jude EB, Malecki MT, Gomez Huelgas R, et al. Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes. Diabetes Ther. 2022;13(4):619–634. doi:10.1007/s13300-022-01222-2Jude EB, Malecki MT, Gomez Huelgas R, et al. Expert Panel Guidance and Narrative Review of Treatment Simplification of Complex Insulin Regimens to Improve Outcomes in Type 2 Diabetes. Diabetes Ther. 2022;13(4):619–634. doi:10.1007/s13300-022-01222-2Ducat L, Philipson LH, Anderson BJ. The mental health comorbidities of diabetes. JAMA. 2014;312(7):691–692Ducat L, Philipson LH, Anderson BJ. The mental health comorbidities of diabetes. JAMA. 2014;312(7):691–692Алгоритмы специализированной медицинской помощи больным сахарным диабетом / Под редакцией И. И. Дедова, М. В. Шестаковой, А. Ю. Майорова. – 11-й выпуск – М.; 2023.Алгоритмы специализированной медицинской помощи больным сахарным диабетом / Под редакцией И. И. Дедова, М. В. Шестаковой, А. Ю. Майорова. – 11-й выпуск – М.; 2023.American Diabetes Association Professional Practice Committee. Summary of revisions: Standards of Care in Diabetes-2024. Diabetes Care 2024;47(Suppl. 1): S5–S10. https://doi.org/10.2337/dc24-SREVAmerican Diabetes Association Professional Practice Committee. Summary of revisions: Standards of Care in Diabetes-2024. Diabetes Care 2024;47(Suppl. 1): S5–S10. https://doi.org/10.2337/dc24-SREVKhunti K, Davies MJ. Clinical inertia versus overtreatment in glycaemic management. Lancet Diabetes Endocrinol. 2018;6(4):266–268Khunti K, Davies MJ. Clinical inertia versus overtreatment in glycaemic management. Lancet Diabetes Endocrinol. 2018;6(4):266–268Ruissen MM, et al. Making diabetes care fit – a re we making progress? Front Clin Diabetes Healthc. 2021 doi: 10.3389/fcdhc.2021.658817Ruissen MM, et al. Making diabetes care fit – a re we making progress? Front Clin Diabetes Healthc. 2021 doi: 10.3389/fcdhc.2021.658817Christiaens A, Henrard S, Boland B, Sinclair AJ. Overtreatment of older people with type 2 diabetes-a high impact frequent occurrence in need of a new definition. Diabet Med. 2023;40(2): e14994. doi:10.1111/dme.14994Christiaens A, Henrard S, Boland B, Sinclair AJ. Overtreatment of older people with type 2 diabetes-a high impact frequent occurrence in need of a new definition. Diabet Med. 2023;40(2): e14994. doi:10.1111/dme.14994Falcetta P, Nicolì F, Citro F, et al. De-intensification of basal-b olus insulin regimen after initiation of a GLP-1 RA improves glycaemic control and promotes weight loss in subjects with type 2 diabetes. Acta Diabetol. 2023;60(1):53–60. doi:10.1007/s00592-022-01974-0Falcetta P, Nicolì F, Citro F, et al. De-intensification of basal-b olus insulin regimen after initiation of a GLP-1 RA improves glycaemic control and promotes weight loss in subjects with type 2 diabetes. Acta Diabetol. 2023;60(1):53–60. doi:10.1007/s00592-022-01974-0Bilic-Curcic I, et al. Comparative efficacy and safety of two fixed ratio combinations in type 2 diabetes mellitus patients previously poorly controlled on different insulin regimens: a multi-centric observational study. Eur Rev Med Pharmacol Sci. 2022;26(8):2782–2793. doi:10.26355/eurrev_202204_28608Bilic-Curcic I, et al. Comparative efficacy and safety of two fixed ratio combinations in type 2 diabetes mellitus patients previously poorly controlled on different insulin regimens: a multi-centric observational study. Eur Rev Med Pharmacol Sci. 2022;26(8):2782–2793. doi:10.26355/eurrev_202204_28608Kalra S, et al. Expert opinion: patient selection for premixed insulin formulations in diabetes care. Diabetes Ther. 2018;9(6):2185–2199Kalra S, et al. Expert opinion: patient selection for premixed insulin formulations in diabetes care. Diabetes Ther. 2018;9(6):2185–2199Giugliano D, et al. Intensification of insulin therapy with basal-bolus or premixed insulin regimens in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Endocrine. 2016;51(3):417–428Giugliano D, et al. Intensification of insulin therapy with basal-bolus or premixed insulin regimens in type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Endocrine. 2016;51(3):417–428Gomez-Peralta F, et al. Titratable fixed-ratio combination of basal insulin plus a glucagon-like peptide-1 receptor agonist: a novel, simplified alternative to premix insulin for type 2 diabetes. Diabetes Obes Metab. 2021;23(7):1445–52Gomez-Peralta F, et al. Titratable fixed-ratio combination of basal insulin plus a glucagon-like peptide-1 receptor agonist: a novel, simplified alternative to premix insulin for type 2 diabetes. Diabetes Obes Metab. 2021;23(7):1445–52Mehta R, et al. Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines. Diabetes Obes Metab. 2020;22(11):1961–1975Mehta R, et al. Practical use of insulin degludec/insulin aspart in a multinational setting: beyond the guidelines. Diabetes Obes Metab. 2020;22(11):1961–1975Men P, et al. Comparison of lixisenatide in combination with basal insulin vs other insulin regimens for the treatment of patients with type 2 diabetes inadequately controlled by basal insulin: systematic review, network meta-analysis and cost-effectiveness analysis. Diabetes Obes Metab. 2020;22(1):107–115Men P, et al. Comparison of lixisenatide in combination with basal insulin vs other insulin regimens for the treatment of patients with type 2 diabetes inadequately controlled by basal insulin: systematic review, network meta-analysis and cost-effectiveness analysis. Diabetes Obes Metab. 2020;22(1):107–115Rosenstock J, et al. Advancing therapy in suboptimally controlled basal insulin-treated type 2 diabetes: clinical outcomes with iGlarLixi versus premix BIAsp 30 in the SoliMix randomized controlled trial. Diabetes Care. 2021;44(10):2361–70Rosenstock J, et al. Advancing therapy in suboptimally controlled basal insulin-treated type 2 diabetes: clinical outcomes with iGlarLixi versus premix BIAsp 30 in the SoliMix randomized controlled trial. Diabetes Care. 2021;44(10):2361–70Hart HE, Ditzel K, Rutten GE, et al. De-I ntensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods Study. Patient Prefer Adherence. 2019; 13:1775–1783. Published 2019 Oct 18. doi:10.2147/PPA.S208947Hart HE, Ditzel K, Rutten GE, et al. De-I ntensification Of Blood Glucose Lowering Medication In People Identified As Being Over-Treated: A Mixed Methods Study. Patient Prefer Adherence. 2019; 13:1775–1783. Published 2019 Oct 18. doi:10.2147/PPA.S208947

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