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Современные аспекты клиники, диагностики и лечения предиабета

https://doi.org/10.20514/2226-6704-2020-10-5-327-339

Аннотация

Предиабет является распространенным нарушением углеводного обмена, медико-социальная актуальность которого обусловлена негативным влиянием на показатели заболеваемости сахарным диабет ом (СД) 2 типа и сердечно-сосудистыми заболеваниями (ССЗ). В анализируемых литературных источниках подчеркивается наличие тесной патогенетической взаимосвязи между СД 2 типа/предиабетом и ССЗ. Эта связь становится еще более актуальной, учитывая, с одной стороны, стойкую тенденцию к росту распространенности нарушений углеводного обмена в популяции, а с другой то обстоятельство, что у пациентов с дизгликемией именно сердечно-сосудистые осложнения являются основной причиной смертности. Однако, если значимость СД 2 типа как фактора риска ССЗ широко известна и его наличие сразу стратифицирует большинство пациентов в группу высокого или очень высокого сердечно-сосудистого риска, то вклад предиабета в развитие ССЗ пока остается недооцененным среди терапевтического и кардиологического сообществ. Высокая распространенность предиабета создает предпосылки для дальнейшего роста заболеваемости СД 2 типа и ССЗ в РФ, что требует от врачей различных специальностей настороженности по раннему выявлению предиабета, поскольку своевременно начатые профилактические мероприятия могут значительно снизить риск развития СД 2 типа и его осложнений в будущем. В настоящий момент подтверждена эффективность как немедикаментозной, так и медикаментозной стратегии в предотвращении развития СД 2 типа у лиц с предиабетом, накапливается все больше данных о возможности эффективной профилактики ССЗ при предиабете. По данным современных исследований подчеркивается первичная роль мероприятий по активному изменению образа жизни при лечении и профилактике предиабета, в то же время, эффективность данных мероприятий может быть снижена из-за недостаточной приверженности самих пациентов к их самостоятельному длительному выполнению. Поэтому стратегия назначения метформина с целью профилактики СД 2 типа является абсолютно оправданной, если врач и пациент признают неэффективность или невозможность длительно следовать рекомендациям по активному изменению образа жизни. В статье с позиций современных рекомендаций представлены данные об этиологии, эпидемиологии, диагностике, а также подходы к ведению пациентов с предиабетом.

Об авторах

Н. В. Пырикова
Федеральное государственное бюджетное образовательное учреждение высшего образования «Алтайский государственный медицинский университет» Министерства здравоохранения Российской Федерации
Россия

Наталья Викторовна Пырикова - кафедра факультетской терапии и профессиональных болезней

Барнаул



И. В. Осипова
Федеральное государственное бюджетное образовательное учреждение высшего образования «Алтайский государственный медицинский университет» Министерства здравоохранения Российской Федерации
Россия

Кафедра факультетской терапии и профессиональных болезней

Барнаул



И. Г. Полякова
Федеральное государственное бюджетное образовательное учреждение высшего образования «Алтайский государственный медицинский университет» Министерства здравоохранения Российской Федерации
Россия

Кафедра факультетской терапии и профессиональных болезней

Барнаул



Список литературы

1. Barbarash O.L., Voevoda M.I., Galstyan G.R. Prediabetes as an interdisciplinary problem: definition, risks, approaches to the diagnosis and prevention of type 2 diabetes and cardiovascular complications. Russian Journal of Cardiology. 2019; 24(4): 83-91. doi: 10.15829/1560-4071-2019-4-83-91 [in Russian].

2. Cho N.H., Shaw J.E., Karuranga S. et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138: 271-281.

3. International diabetes federation. Diabetes Atlas 7th edition. [Electronic resource]. URL: https://www.idf.org/elibrary/epidemiology-research/diabetes-atlas/13diabetes-atlasseventh-edition.html. (date of the application: 17.06.2020).

4. Gujral U.P., Mohan V., Pradeepa R. et al. Ethnic variations in diabetes and prediabetes prevalence and the roles of insulin resistance and cell function: the CARRS and NHANES studies. J ClinTransl Endocrinol. 2016; 4: 19-27. doi: 10.1016/j.jcte.2016.02.004.

5. Мenke A., Casagrande S., Geiss L. et al. Prevalence of and trends in diabetes among adults in the United States, 1988–2012. J Am Med Assoc. 2015; 314: 1021-1029. doi: 10.1001/jama.2015.10029.

6. Andes L.J., Cheng Y.J., Rolka D.B. et al. Prevalence of Prediabetes Among Adolescents and Young Adults in the United States, 2005-2016. JAMA Pediatr. 2019:e194498. doi: 10.1001/jamapediatrics.2019.4498.

7. Konnov M.V., Deev A.D. Own and parental predictors of prediabetes in children of individuals with early coronary heart disease. Cardiology. 2017; 57(6): 16-21. doi: 10.18087/cardio.2019.7.10266 [in Russian].

8. Lyu Y.S., Kim S.Y., Bae H.Y. et al. Prevalence and Risk Factors for Undiagnosed Glucose Intolerance Status in Apparently Healthy Young Adults Aged <40 Years: The Korean National Health and Nutrition Examination Survey 2014-2017. Int J Environ Res Public Health. 2019; 16(13). pii: E2393. doi: 10.3390/ijerph16132393.

9. Wang L., Gao P., Zhang M. et al. Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. JAMA. 2017; 27:2515-2523. doi: 10.1001/jama.2017.7596.

10. Younes N., Atallah M., Alam R. et al. HbA1c and blood pressure measurements: relation with gender, body mass index, study field and lifestyle in Lebanese students. Endocr Pract. 2019; 25(11): 1101-1108. doi: 10.4158/EP-2019-0163.

11. Fazli G.S., Moineddin R., Bierman A.S. et al. Ethnic differences in prediabetes incidence among immigrants to Canada: a populationbased cohort study. BMC Med. 2019; 17(1): 100. doi: 10.1186/s12916-019-1337-2.

12. Dedov I., Shestakova M., Galstyan G. The prevalence of type 2 diabetes mellitus in the adult population of Russia (NATION study). Diabetes. 2016; 19(2): 104-112. doi:10.1016/j.diabres.2016.02.010 [in Russian].

13. Breyer M.K., Ofenheimer A., Altziebler J. et al. Marked differences in prediabetes and diabetes associated comorbidities between men and women — epidemiological results from a general population-based cohort aged 6-80 years — the LEAD (Lung, hEart, sociAl, boDy) study. Eur J Clin Invest. 2020:e13207. doi: 10.1111/eci.13207.

14. Al Amri T., Bahijri S., Al-Raddadi R. et al. The Association Between Prediabetes and Dyslipidemia Among Attendants of Primary Care Health Centers in Jeddah, Saudi Arabia. Diabetes Metab Syndr Obes. 2019; 12: 2735-2743. doi: 10.2147/DMSO.S233717.

15. Мainous A.G., Tanner R.J., Baker R. et al. Prevalence of prediabetes in England from 2003 to 2011: population-based, cross-sectional study. BMJ Open. 2014; 4:e005002. doi: 10.1136/bmjopen-2014-005002.

16. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes — 2018. Diabetes Care. 2018; 41(Suppl 1):S13-S27. doi: 10.2337/dc18-S002.

17. Standards of specialized diabetes care. Edited by Dedov II, Shestakova MV, Mayorov AY. 8th edition. 2017; 20,1S:1-121. doi: 10.14341/DM20171S8.

18. Нuang Y., Cai X., Mai W. et al. Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. BMJ. 2016; 355:i5953. doi: 10.1136/bmj.i5953

19. Zhang Z., Monro J., Venn B.J. Development and Evaluation of an Internet-Based Diabetes Nutrition Education Resource. Nutrients. 2019 May 28;11(6). pii: E1217. doi: 10.3390/nu11061217.

20. Nedogoda S.V., Barykina I.N., Salasyuk A.S. Prediabetes: the main causes, symptoms, prevention and treatment. Medicinal Bulletin. 2018; 12, 70(2): 3-13 [in Russian].

21. Lee M., Saver J.L., Hong K.S. et al. Effect of pre-diabetes on future risk of stroke: meta-analysis. Br Med J. 2012; 344:e3564. doi: 10.1136/bmj.e3564.

22. Huo X., Gao L., Guo L. et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: A crosssectional study. Lancet. Diabetes Endocrinol. 2016; 4: 115-124. doi: 10.1016/S2213-8587(15)00508-2.

23. Hui Y., Wang J., An Y. et al. Premature death and risk of cardiovascular disease in young-onset diabetes: A 23-year follow-up of the Da Qing Diabetes Study. Endocrine. 2019; 65: 46-52. doi: 10.1007/s12020-019-01928-7.

24. Lee G., Kim S.M., Choi S. et al. The effect of change in fasting glucose on the risk of myocardial infarction, stroke, and all-cause mortality: a nationwide cohort study. Cardiovasc Diabetol. 2018; 17: 51. doi: 10.1186/s12933-018-0694-z.

25. Warren B., Pankow J.S., Matsushita K. et al. Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study. Lancet Diabetes Endocrinol. 2017 Jan; 5(1): 34-42. doi: 10.1016/S2213-8587(16)30321-7.

26. Kristensen S.L., Preiss D., Jhund P.S. et al. Risk Related to Pre-Diabetes Mellitus and Diabetes Mellitus in Heart Failure With Reduced Ejection Fraction: Insights From Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial. Circ Heart Fail. 2016; 9(1). pii: e002560. doi: 10.1161/CIRCHEARTFAILURE.115.002560.

27. Saleem S.M., Jan S.S., Haq I. et al. Identification of risk factors affecting impaired glucose metabolism among the adult population of district Srinagar. Diabetes Metab Syndr. 2019; 13(2): 1047-1051. doi: 10.1016/j.dsx.2019.01.023.

28. Rodriguez-Segade S., Rodriguez J., Camiña F. et al. Prediabetes defined by HbA1c and by fasting glucose: differences in risk factors and prevalence. Acta Diabetol. 2019; 56(9): 1023-1030. doi: 10.1007/s00592-019-01342-5.

29. Cuschieri S., Grech S. Closing the gap — Is type 2 diabetes awareness enough to prevent the growing epidemic? Diabetes Metab Syndr. 2019; 13(3): 1739-1744. doi: 10.1016/j.dsx.2019.03.044.

30. Man REK, Charumathi S., Gan ATL. et al. Cumulative incidence and risk factors of prediabetes and type 2 diabetes in a Singaporean Malay cohort. Diabetes Res Clin Pract. 2017; 127: 163-171. doi: 10.1016/j.diabres.2017.03.007.

31. Ligthart S., van Herpt TTW., Leening MJG. et al. Lifetime risk of developing impaired glucose metabolism and eventual progression from prediabetes to type 2 diabetes: a prospective cohort study. Lancet Diabetes Endocrinol. 2016; 4: 44-51. doi: 10.1016/S2213-8587(15)00362-9.

32. Sánchez E., Betriu À., López-Cano C. et al. ILERVAS project collaborators. Characteristics of atheromatosis in the prediabetes stage: a cross-sectional investigation of the ILERVAS project. Cardiovasc Diabetol. 2019; 18(1): 154. doi: 10.1186/s12933-019-0962-6.

33. Helck A., Bianda N., Canton G. et al. Intra-individual comparison of carotid and femoral atherosclerotic plaque features with in vivo MR plaque imaging. Int J Cardiovasc Imaging. 2015; 31: 1611-1618. doi: 10.1007/s10554-015-0737-4.

34. Altin C., Sade L.E., Gezmis E. et al. Assessment of epicardial adipose tissue and carotid/femoral intima media thickness in insulin resistance. J Cardiol. 2017; 69: 843-850. doi: 10.1016/j.jjcc.2016.08.006.

35. Acar B., Ozeke O., Karakurt M. et al. Association of Prediabetes With Higher Coronary Atherosclerotic Burden Among Patients With First Diagnosed Acute Coronary Syndrome. Angiology. 2019; 70(2): 174-180. doi: 10.1177/0003319718772420.

36. Sumin A.N., Bezdenezhnykh N.A., Bezdenezhnykh A.V. Pre-surgery status and in-hospital complications of coronary bypass grafting in prediabetes and type 2 diabetes patients. Russian Journal of Cardiology. 2018; (5): 40-48. doi: 10.15829/1560-4071-2018-5-40-48 [in Russian].

37. Ferrannini E. Definition of intervention points in prediabetes. Lancet Diabetes Endocrinol. 2014; 2: 667-675. doi: 10.1016/S2213-8587(13)70175-X.

38. Buysschaert M., Medina J.L., Bergman M. et al. Prediabetes and associated disorders. Endocrine. 2015; 48: 371-393. doi: 10.1007/s12020-014-0436-2.

39. Wasserman D.H., Wang T.J., Brown N.J. The vasculature in prediabetes. Circ Res. 2018; 122: 1135-1150. doi: 10.1161/CIRCRESAHA.118.311912.

40. Park G.M., Cho Y.R., Lee S.W. et al. Prediabetes is not a risk factor for subclinical coronary atherosclerosis. Int J Cardiol. 2017; 243: 479-484. doi: 10.1016/j.ijcard.2017.05.073.

41. Reis J.P., Allen N.B., Bancks M.P. et al. Duration of diabetes and prediabetes during adulthood and subclinical atherosclerosis and cardiac dysfunction in middle age: the CARDIA study. Diabetes Care. 2018; 41: 731-738. doi: 10.2337/dc17-2233.

42. Krysiak R., Szkróbka W., Okopień B. Sexual functioning and depressive symptoms in men with various types of prediabetes: a pilot study. Int J Impot Res. 2018; 30(6): 327-334. doi: 10.1038/s41443-018-0050-6.

43. Krysiak R., Drosdzol-Cop A., Skrzypulec-Plinta V. et al. Sexual functioning and depressive symptoms in women with various types of prediabetes — a pilot study. Endokrynol Pol. 2018; 69(2): 175-181. doi: 10.5603/EP.2018.0021.

44. Serlachius A., Elovainio M., Juonala M. et al. The Association Between Social Support, Body Mass Index and Increased Risk of Prediabetes: the Cardiovascular Risk in Young Finns Study. Int J Behav Med. 2017; 24(2): 161-170. doi: 10.1007/s12529-016-9597-0.

45. Hilding A., Shen C., Östenson C.G. Social network and development of prediabetes and type 2 diabetes in middle-aged Swedish women and men. Diabetes Res Clin Pract. 2015; 107(1): 166-177. doi: 10.1016/j.diabres.2014.09.057.

46. 2017 IDF clinical practice recommendations for managing type 2 diabetes in primary care. [Electronic resource]. URL: https://www.idf.org/e-library/guidelines/128-idf-clinical-practice-recommendationsformanaging-type-2-diabetes-in-primary-care.html. (date of the application: 17.06.2020).

47. NICE 2017 Type 2 diabetes: prevention in people at high risk. [Electronic resource]. URL: nice. org.uk/guidance/ph38. (date of the application: 17.06.2020).

48. Diabetes Canada Clinical Practice Guidelines Expert Committee, Ekoe JM, Goldenberg R, Katz P. Screening for Diabetes in Adults. Can J Diabetes. 2018; 42 Suppl 1:S16-S19. doi:10.1016/j.jcjd.2017.10.004.

49. Wang G., Radovick S., Xu X. et al. Strategy for early identification of prediabetes in lean populations: New insight from a prospective Chinese twin cohort of children and young adults. Diabetes Res Clin Pract. 2018; 146: 101-110. doi: 10.1016/j.diabres.2018.10.003.

50. Davis P.J., Liu M., Sherman S. et al. HbA1c, lipid profiles and risk of incident type 2 Diabetes in United States Veterans. PLoS One. 2018 Sep 13; 13(9):e0203484. doi:10.1371/journal.pone.0203484.

51. Vistisen D., Witte D.R., Brunner E.J. et al. Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study. Diabetes Care. 2018 Apr; 41(4): 899-906. doi:10.2337/dc17-2530.

52. Paprott R., Scheidt-Nave C., Heidemann C. Determinants of Change in Glycemic Status in Individuals with Prediabetes: Results from a Nationwide Cohort Study in Germany. J Diabetes Res. 2018; 2018: 5703652. doi: 10.1155/2018/5703652.

53. Fares S., Said MSM., Ibrahim W. et al. Accuracy of salivary glucose assessment in diagnosis of diabetes and prediabestes. Diabetes Metab Syndr. 2019; 13(2): 1543-1547. doi: 10.1016/j.dsx.2019.03.010.

54. Mahat R.K., Singh N., Rathore V. Association of myeloperoxidase with cardiovascular disease risk factors in prediabetic subjects. Diabetes Metab Syndr. 2019; 13(1): 396-400. doi: 10.1016/j. dsx.2018.10.016.

55. Mahat R.K., Singh N., Rathore V. et al. Cross-sectional correlates of oxidative stress and inflammation with glucose intolerance in prediabetes. Diabetes Metab Syndr. 2019; 13(1): 616-621. doi: 10.1016/j.dsx.2018.11.045.

56. Yoshida N., Miyake T., Yamamoto S. et al. The Serum Creatinine Level Might Be Associated with the Onset of Impaired Fasting Glucose: A Community-based Longitudinal Cohort Health Checkup Study. Intern Med. 2019; 58(4): 505-510. doi: 10.2169/internalmedicine.0760-18.

57. Jiménez-Lucena R., Camargo A., Alcalá-Diaz J.F. et al. A plasma circulating miRNAs profile predicts type 2 diabetes mellitus and prediabetes: from the CORDIOPREV study. Exp Mol Med. 2018; 50(12): 168. doi: 10.1038/s12276-018-0194-y.

58. Al-Hamdan R., Avery A., Salter A. et al. Identification of Education Models to Improve Health Outcomes in Arab Women with Pre-Diabetes. Nutrients. 2019; 11(5). pii: E1113. doi: 10.3390/nu11051113.

59. Li G., Zhang P., Wang J. et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing diabetes prevention study: a 23-year follow-up study. Lancet Diabetes Endocrinol. 2014; 2(6): 474-480. doi: 10.1016/S2213-8587(14)70057-9.

60. Saslow L.R., Daubenmier J.J., Moskowitz J.T. et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes. 2017; 7(12): 304. doi: 10.1038/s41387-017-0006-9.

61. Sluik D., Brouwer-Brolsma E.M., Berendsen AAM. et al. Protein intake and the incidence of pre-diabetes and diabetes in 4 populationbased studies: the PREVIEW project. Am J Clin Nutr. 2019; 109(5): 1310-1318. doi: 10.1093/ajcn/nqy388.

62. Muscogiuri G., Barrea L., Di Somma C. et al. Patient empowerment and the Mediterranean diet as a possible tool to tackle prediabetes associated with overweight or obesity: a pilot study. Hormones (Athens). 2019; 18(1): 75-84. doi: 10.1007/s42000-018-0090-9.

63. Mirmiran P., Carlström M., Bahadoran Z. et al. Long-term effects of coffee and caffeine intake on the risk of pre-diabetes and type 2 diabetes: Findings from a population with low coffee consumption. Nutr Metab Cardiovasc Dis. 2018; 28(12): 1261-1266. doi: 10.1016/j.numecd.2018.09.001.

64. RezkAllah S.S., Takla M.K. Effects of Different Dosages of Interval Training on Glycemic Control in People With Prediabetes: A Randomized Controlled Trial. Diabetes Spectr. 2019; 32(2): 125-131. doi: 10.2337/ds18-0024.

65. Bock B.C., Dunsiger S.I., Wu W.C. et al. Reduction in HbA1c with Exercise videogames among participants with elevated HbA1c: Secondary analysis of the Wii Heart Fitness trial. Diabetes Res Clin Pract. 2019; 154: 35-42. doi: 10.1016/j.diabres.2019.06.011.

66. Strauss S.M., McCarthy M. Arthritis-Related Limitations Predict Insufficient Physical Activity in Adults With Prediabetes Identified in the NHANES 2011-2014. Diabetes Educ. 2017; 43(2): 163-170. doi: 10.1177/0145721717691849.

67. Sandoval-Rosario M., Nayeri B.M., Rascon A. et al. Prevalence of Arthritis Among Adults with Prediabetes and Arthritis-Specific Barriers to Important Interventions for Prediabetes — United States, 2009-2016. MMWR Morb Mortal Wkly Rep. 2018; 67(44): 1238-1241. doi: 10.15585/mmwr.mm6744a4.

68. Dunbar J.A., Hernan A.L., Janus E.D. on behalf of the Melbourne Diabetes Prevention Study (MDPS) research group, et al. Challenges of diabetes prevention in the real world: results and lessons from the Melbourne Diabetes Prevention Study. BMJ Open Diabetes Res Care. 2015; 3:e000131. doi: 10.1136/bmjdrc-2015-000131.

69. DPPOS. Lancet Diabetes Endocrinol. Published online September 14, 2015. [Electronic resource]. URL: http://dx.doi.org/10.1016/S2213-8587(15)00291-0 (date of the application: 17.06.2020).

70. Garber A.J., Abrahamson M.J., Barzilay J.I. et al. AACE/ACE Comprehensive type 2 diabetes management algorithm 2017. Endocrine Practice. 2017; 23(2): 207-227. doi:10.4158/CS-2018-0535.

71. Goldberg R.B., Temprosa M.G., Mather K.J. et al. Lifestyle and metformin interventions have a durable effect to lower CRP and tPA levels in the Diabetes Prevention Program except in those who develop diabetes. Diabetes Care. 2014; 37(8): 2253-2260. doi: 10.2337/dc13-2471.

72. Mohan M., Al-Talabany S., McKinnie A. et al. Metformin regresses left ventricular hypertrophy in normotensive patients with coronary artery disease without type 2 diabetes mellitus — the met-remodel trial. Heart 2018; 104:A6. doi: 10.1136/heartjnl-2018-BCS.6.

73. Zhou L., Liu H., Wen X. et al. Effects of metformin on blood pressure in nondiabetic patients. J Hypertens. 2017; 35(1): 18-26. doi: 10.1097/HJH.0000000000001119.

74. Goldberg R.B., Aroda V.R., Bluemke D.A. et al. Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium. Circulation. 2017; 136(1): 52-64. doi: 10.1161/CIRCULATIONAHA.116.025483.

75. Ming J., Xu S., Liu C. et al. Effectiveness and safety of bifidobacteria and berberine in people with hyperglycemia: study protocol for a randomized controlled trial. Trials. 2018; 19(1): 72. doi: 10.1186/s13063-018-2438-5.

76. Barthow C., Hood F., McKinlay E. et al. Food 4 Health — He Oranga Kai: Assessing the efficacy, acceptability and economic implications of Lactobacillus rhamnosus HN001 and β-glucan to improve glycated haemoglobin, metabolic health, and general well-being in adults with pre-diabetes: study protocol for a 2 × 2 factorial design, parallel group, placebo-controlled randomized controlled trial, with embedded qualitative study and economic analysis. Trials. 2019; 20(1): 464. doi: 10.1186/s13063-019-3553-7.

77. Atkinson F.S., Villar A., Mulà A. et al. Abscisic Acid Standardized Fig (Ficus carica) Extracts Ameliorate Postprandial Glycemic and Insulinemic Responses in Healthy Adults. Nutrients. 2019; 11(8). pii: E1757. doi: 10.3390/nu11081757.

78. Yoo J.Y., Yum K.S. Effect of Coenzyme Q10 on Insulin Resistance in Korean Patients with Prediabetes: A Pilot Single-Center, Randomized, Double-Blind, Placebo-Controlled Study. Biomed Res Int. 2018; 2018:1613247. eCollection 2018. doi: 10.1155/2018/1613247.


Рецензия

Для цитирования:


Пырикова Н.В., Осипова И.В., Полякова И.Г. Современные аспекты клиники, диагностики и лечения предиабета. Архивъ внутренней медицины. 2020;10(5):327-339. https://doi.org/10.20514/2226-6704-2020-10-5-327-339

For citation:


Pyrikova N.V., Osipova I.V., Polyakova I.G. Modern Aspects of the Clinic, Diagnosis and Treatment of Prediabetes. The Russian Archives of Internal Medicine. 2020;10(5):327-339. https://doi.org/10.20514/2226-6704-2020-10-5-327-339

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