Efficiency of the sodium-glucose linked transporter-2 inhibitors in combination with metformin in patients with diabetes mellitus type 2 and overweight
AbstractThe aim was to evaluate the effect of canagliflozin in combination with Metformin on glucose toxicity and lipotoxicity in patients with type 2 diabetes mellitus and visceral obesity.
Material and methods. We examined 20 patients with diabetes mellitus and visceral obesity who had poor glycemic control. Before inclusion in the study, patients received various oral hypoglycemic therapy. Patients were prescribed hypoglycemic therapy withthe sodium-glucose cotransporter-2 - canagliflozinand metformin 2.0 g/day. Initially and after 6 monthsof therapy, all patients were evaluated in dynamics with their level of fasting glycemia, postprandial glycemia, glycated hemoglobin, weight, BMI, WC, insulin, leptin, adiponectin, insulin resistance using the HOMA-IR index. The patients also underwent daily glycemic monitoring for 3 days, according to which glycemia variability indicators were evaluated: MAGE and SD, as well as the percentage of deviations from normoglycemia (3.9-8.3 mmol/l).
Results and discussion. After 6 months of therapy, a statistically positive changes in fasting glucose level an average 38.9% (p<0.01); postprandial glycemia an average 41.3% (p<0.01); the level of glycated hemoglobin an average 29.8% (p<0.01). The decrease in glycemia variability: MAGE from 5.4±2.1 to 2,9±0,88 mmol/l and SD from 2.07±0.89 to 1.1±0.72. In parallel with the decline in carbohydrate metabolism, a decrease in all anthropometric parameters was obtained: an average BMI of 8.9% (p<0.01), an average weight of 9.02% (p<0.01), waist circumference (WC) on average by 5.88% (p<0.01). In proportion to the reduction of BMI, WC and weight, a decrease in leptin was obtained an average of 51.1% (p<0.01) and inversely proportional increase in the level of adiponectin an average of 120% (p<0.01). Against the background of an increase in adiponectin, a significant decrease in HOMA-IR was recorded on average by 42.3% (p<0.01). In the study of the lipid profile, a positive dynamics of all lipidogram parameters, however, these changes are not statistically significant.
Conclusions. The therapy with canagliflozin and metformin allowed not only reducing glucose toxicity, but also significantly reducing the manifestations of lipotoxicity with restoring the secretion of main adipokines.
Keywords:type 2 diabetes mellitus, canagliflozin, glucose toxicity, lipotoxicity, adiponectin, leptin