Efficacy and pathogenetic justification for the use of vildagliptin in patients with type 2 diabetes mellitus
Background. Dipeptidyl peptidase4 inhibitors, having incretin activity, influence the main pathogenetic mechanisms of type 2 diabetes mellitus (DM). Vildagliptin is an innovative dipeptidyl peptidase4 inhibitor with unique pharmacokinetic characteristics, the efficacy and safety of which have been studied in placebocontrolled studies. The purpose: to study the pharmacotherapeutic efficacy, safety and tolerability of Gliptar produced by PJSC “Kievmedpreparat” (Ukraine) in the treatment of patients with type 2 DM. Materials and methods. The study included 49 patients with type 2 DM. They received metformin monotherapy at a dose of at least 1,000 mg daily for at least the last six months. Duration of type 2 DM averaged 6.2 ± 1.8 years. The patients formed two groups for followup. The first group consisted of 29 patients who were still taking metformin doses up to 2,000 mg/day and additionally received Gliptar (vildagliptin) at a dose of 50 mg twice daily. Patients in the second group (n = 20) continued to receive metformin twice daily at a dose of 2,000 mg/day. Results. After 12 weeks in patients of the first group on the background of metformin therapy combined with vildagliptin, the level of HbA1c decreased significantly to 6.42 ± 0.21 %, fasting glycemia — to 6.14 ± 0.22 mmol/l, postprandial glycemia — to 8.63 ± 0.23 mmol/l. On the background of combined treatment, patients with type 2 DM had a decrease in body weight by 1.18 kg, as well as a tendency to decrease in body mass index from 31.49 ± 1.08 kg/m2 to 29.98 ± 0.76 kg/m2. After treatment, the level of immunoreactive insulin in the first group was 14.08 ± 1.83 µU/ml (baseline 21.11 ± 2.03 µU/ml), HOMAIR — 3.14 ± 0.21 (baseline 6.28 ± 1.42). A significant decrease in carbohydrate metabolism and insulin resistance can be assessed as a positive trend in combination therapy. Conclusions. Given the benefits of dual therapy in the treatment of patients with type 2 DM, according to conventional stepbystep therapy, in the second stage it is advisable to prescribe vildagliptin to patients who receive metformin and who have not reached the target glycemic control. Combination therapy of vildagliptin and metformin provides a comprehensive effect on cardiovascular risk factors in the form of preventing hyperinsulinemia and reducing insulin resistance.
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