No 17 (2015)

Until recently, the sulfonylureas (SM), despite their disadvantages (increased risk of hypoglycaemia and weight gain), remain the drugs of choice of the second - and even, in some cases, the first-line treatment of patients with type 2 diabetes mellitus (DM2) due to their availability. Each new class of tablet hypoglycemic drugs is considered in terms of glucose-lowering effectiveness, and sulfonylureas, first of all, are drugs for the comparison. In recent years, the results of the three direct comparative relatively long-term studies of a new class of anti-diabetic drugs - sodium-glucose cotransporter 2 (SGLT2) inhibitors - and sulfonylureas were published. All three studies have demonstrated a statistically significant benefit of SGLT2 inhibitors compared to sulfonylureas. This review is devoted to the results of these studies. It revaluates the role of sulfonylureas in the treatment of DM2 and discusses the prospect of new possibilities of therapy, taking into account the emergence of a new class of drugs - SGLT2 inhibitors with a comprehensive activity profile.

The problem of osteoarthrosis (OA) and metabolic syndrome (MS) has become urgent now due to increased frequency of obesity and an increase in life expectancy. In the literature, there is evidence on the relationship of OA with metabolic disorders. The main cause of MS is insulin resistance, which starts a vicious circle of symptoms eventually leading to the development of complications, in particular to the initiation and progression of OA. The review describes the recent literature data on the relationship of OA and MS, shows the role of weight loss on the clinical manifestations of OA.

Obesity is an important risk factor for cardiovascular diseases. The obesity epidemic is associated with changes in social, economic, cultural and physical environment, with a sedentary lifestyle and poor diet. The basis for the treatment of obesity and prevention of cardiovascular disease are a healthy diet and increasing physical activity. If they are ineffective, pharmacotherapy (orlistat) should be assigned given that it is safe and effective. The US Food and Drug Administration also registeredlorcaserin, liraglutide, phenteramine/ topiramate and naltrexone/bupropion sustained release for the long-term treatment of obesity. The issue of long-term reduction in cardiovascular risks against the background of the modern pharmacotherapy of obesity remains open.

The study among 160 patients with type 2 diabetes mellitus was performed in real clinical practice to the evaluation of the quality of life, frequency of hypoglycemia, and the problems associated with this condition, against the background of application of a combined hypoglycemic therapy: vildagliptin+metformin (study group) or sulfonylurea (SU)+metformin (comparison group). It was found that the quality of life in patients on therapy with vildagdiptin+metformin was significantly higher compared with treatment using SU+metformin. It was also shown that patients receiving combination therapy using vildagliptin in combination with metformin, experienced significantly less hypoglycemia episodes during last 6 months than patients receiving combined therapy with metformin and SU.

It is well known that timely initiation of insulin therapy in patients with type 2 diabetes mellitus (DM2) allows to maintain the possibility of secretion of patient’s own insulin for a longer period by reduction of glucose toxicity. In some cases, this can lead to a complete abolition of insulin therapy while maintaining a sufficient level of compensation of carbohydrate metabolism. On the other hand, late start of insulin therapy, as well as late intensification of insulin therapy against the background of chronic decompensated carbohydrate metabolism in DM2 patients often leads to premature exhaustion of patients’ own insulin secretion, and the earlier development of diabetic complications and/or emergency conditions. The results of the monitoring indicate that the initiation or intensification of insulin therapy in 197 patients who did not have the target level of glycemic control against the background of treatment with oral hypoglycemic agents or previously received insulin therapy has resulted in a significant reduction in both fasting and postprandial glucose levels, as well as the levels of glycated hemoglobin (HbAic). As early as in the first 3 months of therapy with genetically engineered insulin (Biosulin P and Biosulin H), 23% of patients reached target HbAic levels, and 56% of patients reached HbAic levels <8.0%. There were no severe hypoglycemia, local reactions and serious adverse events during follow-up.

Proper glycemic control during pregnancy reduces the risk of maternal, fetal and neonatal complications. Therefore, insulin therapy is the mainstay of therapy of type 1 and 2 diabetes mellitus in pregnant women, as well as gestational diabetes. The purpose of the review -analysis of efficacy and safety of insulin detemir - the first basal insulin analogue approved for use during pregnancy (category B, FDA). The improved pharmacokinetic and pharmacodynamic profiles, low variability of action and great predictability of the clinical effect of insulin detemir provide the optimal glycemic control with a low risk of hypoglycemia and neutral effect on body weight. The clinical benefits of insulin detemir is confirmed by the results of clinical studies in pregnant women with diabetes mellitus that allows to recommend insulin detemir as a first-line therapy when choosing long-acting insulin for treatment of diabetes mellitus in pregnant women.