Management of newly diagnosed diabetes mellitus type 2: early intervention therapy aimed on lipotoxicity and glucotoxicity
AbstractAim: improve management of diabetes mellitus type 2 by early intervention therapies aimed at correcting glucotoxicity and lipotoxicity.
Methods. Patients with newly diagnosed diabetes mellitus type 2 evaluated the glycemic and lipid profile, free fatty acids, fatty acids spectrum in blood serum, body composition dual energy absorptiometry during therapy with metformin and sibutramine.
Results. The subjects were 60 patients with diabetes duration of not more than 6 months. They were distributed to the primary group and the comparison group: 30 patients were treated with metformin, and sibutramin, others accept only biguanide. The average age of patients was 51,8±8,4 years (25% male, 75% female). Anthropometric data of the patients were obese II class (BMI – 35,3±4,87), in addition, all patients had visceral obesity according to waist-hip index – 0,97±0,08. After 6 months of treatment in the study group there was a decrease in body weight of 11,3 kg (p≤0,05), index waist-hip decreased by 0,056 (p≤0,05), according to BMI, patients in the study group were obese 1 class in the compare group significant changes of these parameters have been identified. Body composition in the main group also improved: the index of visceral/subcutaneous fat decreased by 0,09 (p≤0,09), total fat mass to 4 kg (p≤0,05), the average amount of fatty tissue in the body to 2,6 kg (p≤0,05). On the background of the therapy patients improved metabolic parameters. In the study group, HbA1c levels decreased significantly to 6,32±0,74% (p≤0,05), fasting glucose indicators and postprandial glycemia also reached the target values. Furthermore, there was a significant reduction in total cholesterol from 5,3±1,3 to 4,8±1,01 mmoles/l (p≤0,05) compared with the group on metformin. The overall level of FFA in our study did not reach toxic values used in experimental studies, which is probably due to the rapid metabolism of fatty acids into the mitochondria. At the start of the study in the main group, the mean level was 0,61±0,204 mgekv/l, and after treatment there was a decrease to 0,48±0,16 (p≤0,05). Just be interesting to estimate the spectrum of fatty acids that will demonstrate the features of the «western diet» typical for residents of large cities, as well as to identify the proportional content of saturated and unsaturated fatty acids in the blood of patients with diabetes mellitus type 2 and obesity. In the main group level of palmitic acid (according to research the most toxic of the saturated fatty acids) was 856,2±265,9, in the comparison group experienced a similar level. Upon completion of the research level of palmitic acid in the study group was significantly decreased to 674,6±186,3 (p<0,05). The content of unsaturated fatty acids was low in both groups at the start of the study. After 6 months, there was a decrease in the absolute number of the main group (p≤0,08), and in the control group no significant changes were detected. This fact is probably due to the significant weight loss and changes in dietary habits.
Conclusion. In our study, was shown to effectively manage diabetes at an early stage of the disease with the help of weight loss and the amount of visceral fat and correction lipotoxicity glucotoxicity that provides metabolic and glycemic control in the long term.
Keywords:diabetes mellitus type 2, lipotoxicity, glucosetoxicity