The role and place of sodium-glucose cotransporter-2 inhibitors in multifactorial management of type 2 diabetes mellitus

• Alexander S. Ametov
• Evgeniya Yu. Pashkova
• Sharafetdinov Andrey S.
• Zhigareva Anna V.

Abstract

The aim of the study is to assess the effect of therapy with canagliflozin and metformin on carbohydrate and fat metabolism in patients with type 2 diabetes mellitus and visceral obesity.

Methods. A total of 20 patients with diabetes mellitus and visceral obesity with poor glycemic control were examined. Before being included in the study, patients received various oral hypoglycemic therapy: 5 patients received monotherapy with metformin, 4 patients receives monotherapy with sulfonylurea, 5 patients received combination therapy with metformin and sulfonylurea, 1 patients received combination therapy with metformin and DPP-4 inhibitors. And 5 patients were with new-onset type 2 diabetes mellitus. The average age of patients was 54.05±12.1 years. Patients received laboratory and instrumental methods of research. Patients were prescribed hypoglycemic therapy with sodium-glucose cotransporter 2 inhibitors - canagliflozin in a dose of 100 or 300 mg and metformin 2000 mg. The duration of treatment and observation of patients was 6 months, after which a follow-up examination was performed.

Results. The therapy with canagliflozin and metformin for 6 months allowed to obtain physiological values of the glycemic profile 95% of the time, completely excluding the presence of both glucose toxicity and glucose deficiency. Against the background of the stabilization of glycemic parameters, we obtained a significant decrease in all anthropometric indices. It is important to note, that we recorded a proportional decrease in BMI, body weight, waist circumference and a decrease in the level of leptin, and an inversely proportional increase in the level of adiponectin, a key marker of metabolic health. In turn, an increase in adiponectin levels was accompanied by an improvement in insulin sensitivity and a regression of metabolic changes.

Conclusion. The therapy of canagliflozin and metformin allows not only to achieve the classical goals of treatment of type 2 diabetes melllitus, such as achieving individual goals of glycemic control and weight loss, but also significantly reduce the manifestations of lipotoxicity, as well as normalize the disturbed balance between key adipokines, restoring metabolic health.

Keywords:type 2 diabetes mellitus, leptin, adiponectin, canagliflozin, visceral obesity, metabolic health markers

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