Международный неврологический журнал Том 21, №6, 2025
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Інсулінорезистентність, депресія і цукровий діабет 2-го типу
Авторы: Сергієнко О.О. (1), Чемерис О.М. (1), Паньків В.І. (2), Сергієнко В.О. (1)
(1) - Державне некомерційне підприємство «Львівський національний медичний університет імені Данила Галицького», м. Львів, Україна
(2) - Український науково-практичний центр ендокринної хірургії, трансплантації ендокринних органів
і тканин МОЗ України, м. Київ, Україна
Рубрики: Неврология
Разделы: Справочник специалиста
Версия для печати
Резюме
Цукровий діабет (ЦД) 2-го типу та депресія є значними проблемами глобальної охорони здоров’я. Зокрема, приблизно 26–30 % хворих на ЦД страждають від депресії різного ступеня тяжкості, а ЦД 2-го типу подвоює ризик розвитку депресії. Розвиток депресії може бути зумовлений поведінковими чинниками, серед яких виділяють незбалансовані харчові звички, ожиріння, недостатню фізичну активність, соціальну нестабільність, зловживання психоактивними речовинами, порушення режиму сну. Інсулінорезистентність (ІР) — це одна з провідних ознак ЦД 2-го типу, що має різні форми, специфічні для певних тканин. Зокрема, периферична ІР проявляється зниженням поглинання глюкози скелетними м’язами та жировою тканиною через дефекти функціонування рецепторів інсуліну і порушення сигнальних шляхів. ІР клітин головного мозку пов’язана зі зміною сигналізації інсуліну в нейронах і гліальних клітинах, асоціюється з нейродегенеративними процесами, що пов’язує її як зі зниженням когнітивних здібностей, так і з розладами настрою. Існує кілька гіпотез щодо спільних факторів ризику, таких як психологічний вплив управління хронічним захворюванням, потенційно спільна генетична схильність або патофізіологічні порушення. Останні включають дисфункцію регуляції гіпоталамо-гіпофізарно-адреналової осі, активацію процесів хронічного запалення низької інтенсивності (ХЗНІ), зміни стану вегетативної нервової системи, дисфункцію симпатоадреналової системи; порушення регуляції інсулінової сигналізації та нейротрансмісії; активацію процесів оксидативного стресу і мітохондріальну дисфункцію; порушення гомеостазу кишкової мікробіоти і дисфункцію осі кишечник — мозок; дисфункціональність нейротрофічного фактора головного мозку; зміну синаптичної пластичності нейронів; порушення процесів автофагії. Водночас повідомляється, що взаємозв’язок між ЦД 2-го типу та підвищеним ризиком розвитку депресивних симптомів частково пояснюється підвищеним рівнем біомаркерів мікросудинної дисфункції, нейродегенерації, кінцевих продуктів глікування та артеріальної жорсткості. Проте значний вплив процесів ХЗНІ не був виявлений. Мета огляду: провести аналіз сучасного стану проблеми особливостей взаємозв’язків між ІР, депресією та ЦД 2-го типу, а також проаналізувати нові тенденції та напрямки майбутніх досліджень. Пошук проводився в Scopus, Science Direct (від Elsevier) і PubMed, включно з базами даних Medline. Використано ключові слова «інсулінорезистентність», «депресія», «цукровий діабет 2-го типу», «нейротрофічний фактор головного мозку». Для виявлення результатів досліджень, які не вдалося знайти під час онлайн-пошуку, використовувався ручний пошук бібліографії публікацій.
Type 2 diabetes mellitus (T2DM) and depression are significant global health problems. In particular, approximately 26–30 % of people with diabetes suffer from depression of varying severity, and T2DM doubles the risk of developing depression. The latter can be caused by behavioral factors, including unbalanced eating habits, obesity, physical inactivity, social instability, substance abuse, and sleep disturbances. Insulin resistance (IR), one of the leading signs of T2DM, has different forms specific to certain tissues. In particular, peripheral IR is manifested by reduced glucose uptake by skeletal muscles and adipose tissue due to defects in insulin receptor function and signaling pathways. IR of brain cells is associated with changes in insulin signaling in neurons and glial cells, with neurodegenerative processes, which links it to both cognitive decline and mood disorders. There are several hypotheses regarding common risk factors, such as the psychological impact of managing a chronic disease, potentially shared genetic predisposition, or pathophysiological disorders. The latter include dysregulation of the hypothalamic-pituitary-adrenal axis, activation of chronic low-grade inflammation, changes in the autonomic nervous system, dysfunction of the sympathoadrenal system, dysregulation of insulin signaling and neurotransmission, activation of oxidative stress processes and mitochondrial dysfunction, disturbance of intestinal microbiota homeostasis and dysfunction of the gut-brain axis, dysfunction of brain-derived neurotrophic factor, changes in synaptic plasticity of neurons, and disruption of autophagy. At the same time, it is reported that the relationship between T2DM and an increased risk of developing depressive symptoms is partly explained by increased levels of biomarkers of microvascular dysfunction, neurodegeneration, advanced glycation end products, and arterial stiffness. However, a significant impact of chronic low-grade inflammation processes has not been identified. The review aimed to examine the current state of research on the relationship between IR, depression, and T2DM, and to identify new trends and directions for future research. The search was conducted in Scopus, ScienceDirect (from Elsevier), and PubMed, including MEDLINE databases. The keywords used were “insulin resistance”, “depression”, “type 2 diabetes”, and “brain-derived neurotrophic factor”. A manual search for the bibliography of publications was used to identify research results that could not be found during the online search.
Ключевые слова
інсулінорезистентність; депресія; цукровий діабет 2-го типу; нейротрофічний фактор головного мозку; огляд літератури
insulin resistance; depression; type 2 diabetes mellitus; brain-derived neurotrophic factor; literature review
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