Peculiarities of outpatient glycemic profile of patients with type 2 diabetes mellitus during innovative sugar-reducing therapy combined with metformin according to flash glucose monitoring data

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Abstract

Nowadays, innovative hypoglycemic metformin-combined therapy is recommended for a large number of patients with type 2 diabetes mellitus (T2 DM). Analysis of the ambulatory glycemic profile (AGP) and glycemic variability (GV) of patients can be informative when choosing the priority of prescribing dipeptidyl peptidase-4 (DPP-4) inhibitors or sodium-glucose cotransporter type 2 (SGLT-2) inhibitors.

The aim: to compare AGP and GA indexes in groups of patients with T2 DM receiving innovative glucose-lowering therapy combined with metformin.

Material and methods. The results of flash glucose monitoring (FMG) were assessed in 56 patients with type 2 diabetes mellitus aged from 45 to 60 years with an HbA1c level of ≤7,5% and disease duration of ≤5 years, receiving a combination of metformin and DPP-4 inhibitors or metformin and SGLT-2 inhibitors. For FMG, the FreeStyle Libre system (Abbott) was used.

Results. Mean sensor activity time was 86±9 (95%CI: 83–90) % and 85±9 (95%CI: 81–89) % in the groups of patients receiving metformin + DPP-4 inhibitors and metformin + SGLT-2 inhibitors, respectively. The time the glucose level was in the target range in the same groups was 91 [84–97] % versus 95 [87–97] %, the number and total duration of hypoglycemia episodes was 4 [1–16] times and 126 [45–186] minutes versus 3 [1–8] times and 90 [30–165] minutes, respectively. These differences were not statistically significant. When analyzing GV, statistically significant differences were observed only in relation to HBGI index: 1,12 [0,63–1,90] in the metformin + DPP-4 inhibitors group versus 2,17 [1,06–3,25] in the metformin + SGLT-2 inhibitors group (p=0,030). Differences in LI index (3,11 [1,76–3,85] vs. 4,45 [2,30–5,25]), J-index (15,23 [12,38–19,52] vs. 17,14 [13,99–23,43]) and ADDR (7,85 [3,22–13,00] index vs. 6,48 [4,30–14,61]) were not statistically significant (p >0,05).

Conclusion. In analyzed sample, among patients with type 2 diabetes mellitus receiving metformin + SGLT-2 inhibitors, the risk of hyperglycemia was significantly higher than in the group using metformin + DPP-4 inhibitors.

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About the authors

Anna S. Teplova

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Author for correspondence.
Email: anna_kochina_@mail.ru
ORCID iD: 0000-0002-6826-5924

Assistant at the Department of Endocrinology of the Faculty of General Medicine

Russian Federation, Moscow

Tatyana Yu. Demidova

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: t.y.demidova@gmail.com
ORCID iD: 0000-0001-6385-540X

MD, Professor, Head of the Department of Endocrinology of the Faculty of General Medicine

Russian Federation, Moscow

Kristina G. Lobanova

N.I. Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia

Email: miss.sapog@mail.ru
ORCID iD: 0000-0002-3656-0312
SPIN-code: 6044-1684

PhD in Medical Sciences, Assistant at the Department of Endocrinology of the Faculty of General Medicine

Russian Federation, Moscow

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2. Fig. 1. Example of outpatient glycemic profile in a patient treated with the combination of metformin + sodium-glucose cotransporter inhibitor type 2

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3. Fig. 2. Example of outpatient glycemic profile of a patient treated with the combination of metformin + dipeptidyl peptidase-4 inhibitor

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