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Место препарата манинил® в современной стратегии лечения сахарного диабета типа 2

magazine-vrach-2012-08-011

Место препарата манинил® в современной стратегии лечения сахарного диабета типа 2

В арсенале пероральных сахароснижающих препаратов глибенкламид (Манинил®) сохраняет лидирующие позиции как наиболее эффективное по своей гипогликемизирующей активности средство. Эффективность препарата обусловлена его уникальной химической структурой, содержащей не только сульфонилмочевинное кольцо, но и бензамидную группировку в боковой цепи, что обеспечивает максимальное сродство к рецептору сульфонилмочевины-1 (СМ1 – SUR1) на β-клетках аденозинтрифосфатзависимых К+-каналов, с одной стороны, и возможность связывания с SUR2А на таких клетках периферических тканей, как кардиомиоциты, гладкомышечные клетки сосудистой стенки и нейроциты – с другой. Вместе с тем данная особенность может повышать риск гипогликемических состояний и оказывать негативное влияние на сердечнососудистую систему. Рассматриваются данные клинических исследований, доказывающих эффективность и безопасность препарата, получившего в 2010 г. Премию лекарственных средств Г.Г. Крейтцфельдта на основе доказательной базы долгосрочных наблюдений, продемонстрировавших снижение риска сосудистых осложнений сахарного диабета, возможность легко комбинироваться с препаратами других групп, назначения пожилым и мультиморбидным пациентам. Глибенкламид – единственный препарат СМ, внесенный в список жизненно важных лекарственных средств ВОЗ.
Place of maninil® in current treatment policy for type 2 diabetes mellitus
Among oral glucose-lowering drugs, glibenclamide (Maninil®) continues to maintain its leading positions as the most effective hypoglycemic agent. The efficacy of the drug is due to its unique chemical structure that contains not only a sulfonylurea ring, but also a benzamide group in the side chain, which ensures the highest affinity for sulfonylurea (SU) receptor 1 (SUR1) on the β-cells of adenosine phosphate-dependent K+ channels, on the one hand, and its ability to bind to SUR2A on the peripheral tissue cells, such as cardiomyocytes, vascular wall smooth muscle cells, and neurocytes, on the other hand. At the same time, this peculiarity can increase the risk of hypoglycemic states and have a negative impact on the cardiovascular system. The data of the clinical trials proving the efficacy and safety of the drug that received the 2010 G.G. Creutzfeldt Drug Prize due to the evidence-based long-term follow-ups demonstrating the reduced risk of vascular complications of diabetes mellitus, its capacity of combining with medicines of other groups, its use in elderly and multimorbid patients. Glibenclamide is the only SU agent entered into the WHO’s list of essential medicines.

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