Статины и СД 1 типа

[EkaterinaMak]

Прошу совета---требуется ли медикаментозная коррекция дислипидемии у пациентки 18 лет с СД 1 типа (дебют в 3,5 года), ОХ-7,3; ТГ-N; ЛПНП-4,5? Заранее спасибо!

[J_Kom]

А почему возникли сомнения? Конечно же да!

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Уровень ЛПВП?
Компенсация диабета (HbA1c)? Осложнения?
ТТГ?
Регулярность менструаций?
Курение?
ИМТ?

Липидемия исследовалась однократно?

[EkaterinaMak]

ЛПВП-сейчас не скажу..HbA1c-7,2,диабетическая нефропатия,стадия МАУ,полинейропатия. ИМТ-25, курение-отрицает,менструации не регулярные,со слов пациентки,ранее тоже отмечалось повышение холестерина...

[EkaterinaMak]

ТТГ- в работе.

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До получения результатов ТТГ давайте подождём со статинами.
Ингибиторы АПФ либо сартаны девочка, конечно, получает?
Для 18-летнего подростка гликированный 7,2% неплохо, конечно, но хотелось бы меньше 7%. Там нет хронической передозировки инсулина? - девочка полненькая.
АД не повышается?
Причины нерегулярного менструального цикла установлены?

[EkaterinaMak]

Ольга Юрьевна,спасибо за ответ! Я в больнице не каждый день-результаты ТТГ выложу в пятницу.Да,девочка полненькая,давление не повышается-120/80,эналаприл-2,5мг. Причину нерегулярного м.ц. пока не установили...

[EkaterinaMak]

ТТГ-1.65

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ОК, здесь всё нормально. Хорошо бы ещё девочку гинекологам показать на предмет СПКЯ. Метформин не хотите добавить?
Статины можно дать. Начните с небольшой дозы, через месяц проконтролируйте липидемию.

[EkaterinaMak]

По поводу метформина в сомнениях... А ссылок на работы о применении метформина у страдающих сахарным диабетом 1 типа, с инсулинорезистентностью на фоне избыточной массы тела нет??

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Ссылок по применению метформина при диабете 1-го типа - море (загляните в PubMed).
Вот первые, что попались:

Effect of adjunct metformin treatment in patients with type-1 diabetes and persistent inadequate glycaemic control. A randomized study.Lund SS, Tarnow L, Astrup AS, Hovind P, Jacobsen PK, Alibegovic AC, Parving I, Pietraszek L, Frandsen M, Rossing P, Parving HH, Vaag AA.
Steno Diabetes Center, Gentofte, Denmark. [Ссылки доступны только зарегистрированным пользователям ]
BACKGROUND: Despite intensive insulin treatment, many patients with type-1 diabetes (T1DM) have longstanding inadequate glycaemic control. Metformin is an oral hypoglycaemic agent that improves insulin action in patients with type-2 diabetes. We investigated the effect of a one-year treatment with metformin versus placebo in patients with T1DM and persistent poor glycaemic control. METHODOLOGY/PRINCIPAL FINDINGS: One hundred patients with T1DM, preserved hypoglycaemic awareness and HaemoglobinA(1c) (HbA(1c)) > or = 8.5% during the year before enrolment entered a one-month run-in on placebo treatment. Thereafter, patients were randomized (baseline) to treatment with either metformin (1 g twice daily) or placebo for 12 months (double-masked). Patients continued ongoing insulin therapy and their usual outpatient clinical care. The primary outcome measure was change in HbA(1c) after one year of treatment. At enrolment, mean (standard deviation) HbA(1c) was 9.48% (0.99) for the metformin group (n = 49) and 9.60% (0.86) for the placebo group (n = 51). Mean (95% confidence interval) baseline-adjusted differences after 12 months with metformin (n = 48) versus placebo (n = 50) were: HbA(1c), 0.13% (-0.19; 0.44), p = 0.422; Total daily insulin dose, -5.7 U/day (-8.6; -2.9), p<0.001; body weight, -1.74 kg (-3.32; -0.17), p = 0.030. Minor and overall major hypoglycaemia was not significantly different between treatments. Treatments were well tolerated. CONCLUSIONS/SIGNIFICANCE: In patients with poorly controlled T1DM, adjunct metformin therapy did not provide any improvement of glycaemic control after one year. Nevertheless, adjunct metformin treatment was associated with sustained reductions of insulin dose and body weight. Further investigations into the potential cardiovascular-protective effects of metformin therapy in patients with T1DM are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT00118937.



Metformin added to insulin therapy for type 1 diabetes mellitus in adolescents.Abdelghaffar S, Attia AM.
Pediatrics, Pediatric Endocrinology and Diabetes, Cairo University.
BACKGROUND: In adolescents with type 1 diabetes, insulin resistance likely plays a role in the deterioration of metabolic control. In type 1 diabetes, addition of metformin to insulin therapy, to improve insulin sensitivity, has been assessed in a few trials involving few patients or in uncontrolled studies of short duration. No systematic reviews are available up to date to summarize the evidence about metformin addition to insulin therapy in adolescents with type 1 diabetes. OBJECTIVES: To assess the effects of metformin added to insulin therapy for type 1 diabetes mellitus in adolescents. SEARCH STRATEGY: We searched The Cochrane Library, MEDLINE and EMBASE. We also searched databases of ongoing trials, reference lists of relevant reviews, and we contacted experts, authors and manufacturers. SELECTION CRITERIA: Any randomised controlled trial (RCT) of at least three months duration of treatment comparing metformin added to insulin therapy versus insulin therapy alone in adolescents with type 1 diabetes was included. Cross-over and quasi-randomised controlled trials were excluded. DATA COLLECTION AND ANALYSIS: Two reviewers read all abstracts, assessed quality and extracted data independently. Authors were contacted for missing data. MAIN RESULTS: Only two trials (60 participants) investigating the effect of metformin added to insulin therapy for three months in adolescents with poorly controlled type 1 diabetes could be included. Meta-analysis was not possible due to the clinical and methodological heterogeneity of data. Both studies suggested that metformin treatment lowered glycosylated haemoglobin A1c (HbA1c) in adolescents with type 1 diabetes and poor metabolic control. Improvements in insulin sensitivity, body composition or serum lipids were not documented in either study, however, one study showed a decrease in insulin dosage by 10%. Adverse effects were mainly gastrointestinal in both studies and hypoglycaemia in one study. No data on health-related quality of life, all-cause mortality or morbidity are currently available. AUTHORS' CONCLUSIONS: There is some evidence suggesting improvement of metabolic control in poorly controlled adolescents with type 1 diabetes, on addition of metformin to insulin therapy. Stronger evidence is required from larger studies, carried out over longer time periods to document the long-term effects on metabolic control, health-related quality of life as well as morbidity and mortality in those patients.