Tactics of hypoglycemic treatment in patients with pancreatogenic diabetes: a prospective study

Background. Pancreatogenic diabetes (PD) is secondary to diseases of the pancreas. The prevalence of PD according to some data; is up to 9–10% of all cases of DM; which is comparable in frequency to type 1 DM (DM1). The tactics for choosing glucose-lowering treatment in patients with various forms of PD have not yet been fully determined; the effectiveness and tolerability of the drug in this disease have not been sufficiently studied.

Objective. Development of criteria for the safety and effectiveness of glucose-lowering treatment in patients with PD

Methods. Initially; 133 patients who had been diagnosed with pancreatitis and PD that developed as a result were followed-up. 81 (60.9%) patients – 65 men and 16 women aged 54.7±9.3 years – completed the study. Patients were randomized (envelope method) into groups differing in the treatment regimens used. In group A (therapy with insulin drugs); 37 patients completed the study; in group B (therapy with metformin; including in combination with insulin drugs) – 44 patients. Personal and family history; the structure of the pancreas according to radiation imaging methods; biochemical parameters; and the effectiveness of therapy were assessed’ and search for prognostic criteria for the effectiveness and safety of treatment was performed.

Results. The main risk factors for PD have been identified. It was found that the use of metformin in PD as monotherapy or in combination with insulin drugs improved glycemic control; reduced insulin doses; reduced the frequency of relapses of pancreatitis and the risk of of renal dysfunction. Clinical and laboratory criteria to predict the effectiveness and safety of glucose-lowering treatment for PD have been statistically substantiated.

Conclusion. The data obtained make it possible to substantiate the feasibility of using metformin as monotherapy or in combination with insulin; and to formulate recommendations for choosing the optimal tactics of drug therapy that provides a high clinical effect with satisfactory tolerability.