Застосування метформіну у пацієнтів з цукровим діабетом типу 2 та ожирінням, які перебувають на монотерапії інсуліном

Abstract

Обстежено 26 пацієнтів з цукровим діабетом типу 2 на монотерапії інсуліном з неоптимальним контролем глікемії. Всім пацієнтам в якості додаткової терапії було додано метформін у дозі 2000-3000 мг Позитивного ефекту від терапії було досягнуто у 22 (84,6 %) пацієнтів. Було досягнуто не лише зниження глюкози та глікозильованого гемоглобіну, а й поліпшення ряду інших показників, які є незалежними факторами кардіо-васкулярного ризику у даної групи пацієнтів, що підтверджує доцільність застосування такого виду терапії.

Обследовано 26 пациентов с сахарным диабетом 2 типа и ожирением, которые получали монотерапию инсулином и имели неоптимально контролируемый диабет. Всем пациентам в качестве терапии было добавлено метформин в дозе 2000-3000мг. Положительный эффект от лечения был достигнут у 22 (84,6 %) пациентов. У них было достигнуто не только стойкое снижения уровней глюкозы и гликозилированного гемоглобина, но и улучшение целого ряда других показателей, которые являются независимыми факторами кардио-васкулярного риска у данной группы пациентов: уменьшение массы тела и окружности талии, снижение уровней холестерина и триглицеридов крови. Полученные данные подтверждают целесообразность использования метформина у данной категории пациентов.

This article is devoted to actual problem of treatment for obese patient with type 2 diabetes mellitus. Current guidelines for treatment patients with type 2 diabetes mellitus provide recommendation for usage of metformin as basic therapy for all patients with type 2 diabetes mellitus. The target of this study was to evaluate the efficacy of additional using of metformin in therapy of patients with type 2 diabetes mellitus and obesity, which received high doses insulin monotherapy and have poor glycaemic control. Subject and methods o f study. We have observed 26 patients with type 2 DM at age 44 to 68 y. o. The criteria to entrance to the study were: history of type 2 DM more than 5 years, history of treatment with insulin more than 3 years, HbA1c > 8.0 %, BMI > 80 %, daily insulin dose > 1 lU/kg or > 100 IU. In the start of study patients had average history of diabetes 12,7 ± 0,96 years. All patent had received insulin as monotherapy of diabetes during 5,8 ± 0,48 years. Results o f study. Add of metfotmin had good compliance, had not any significant side effects and provide positive effects for diabetes mellitus at most of subjects. Dose of metformin was successfully up-titrated to 2000-3000 mg for all patients. Reduction of HbA1c level was register at 22 patients (84,6 %) after three months of treatment. 4 patients had lack or negative changes. Patients, which had not reduction in HbA1c level, were excluded from the study. Reduction of glycaemia and HbA1c had been achieved at patient, who had stable tendency to previous increase of them, which had place with increase of dose of insulin. All patients received insulin in intensive regimen - the final step of insulin therapy. That’s why we can speak about reduction of insulin-resistance at these patients. HbA1c level were 7,9 ± 0,45 %, 8,1 ± 0,52 %, 7,8 ± 0,41 % at 3, 6 and 12 months. Difference with initial level were - 0,7 %, - 0,5 % та - 0,8 %. Such results demonstrate good efficacy of this kind of therapy. Also we had register weight loss at 21 patients with average rate 3,2 ± 0,6 kg. This change was not significant, but it was achieved at patients who had stable increase of weight in previous years. We had register reduction of waist circumference - one more actual indicator of obesity and insulin-resistance. Reduction of waist circumference from 123,5 to 120,3 cm is a marker of reduction of CV risk. Positive changes in lipids levels also were shown. 18 patients received statins in the entrance and during the study. Patient had not changes in lipid-lowering treatment. All patients had sub- or normal levels of cholesterol and triglycerides. But 1 year after add of metformin we had register significant reduction of total cholesterol, LDL and triglycerides (р < 0,05). Reduction of triglycerides was more significant. High triglycerides level is one of typical characteristics of diabetic dyslipidaemia and independent factor of CV risk. Patients had received statins, but this drugs have poor effect for reduction of triglycerides. That’s why additional reduction of triglycerides level with usage of metformin can improve lipid-lowering therapy and provide improvement of prevention of CV events. Changes in lipids levels may be the secondary result of improvement of glycaemic control or primary effect of metformin. We had not observed changes of blood pressure during the study, because patients had changes in antihypertensive treatment for achieve target levels of blood pressure. Conclusions. Add of metformin for treatment of insulin-resist patients with type 2 Diabetes Mellitus, who are currently treated with insulin, can improve glycaemic control, further to weight loss and has additional positive effects, specifically for metabolism of lipids.