Voglibose in Combination of Three Hypoglycemic Agents in the Treatment of Type 2 Diabetes Mellitus
The aim of the study — clinical and metabolic rationale for the selection of the third hypoglycemic agent to enhance the effectiveness of treatment in patients with diabetes mellitus (DM) type 2, assessment of the impact of the therapy intensification due to the addition of voglibose on carbohydrate metabolism parameters, which have not reached target levels during the combination therapy with metformin and glimepiride. Materials and methods. We observed 45 patients with DM type 2, who have not reached the targets of carbohydrate metabolism under the influence of previous treatments (metformin and glimepiride). After the initial clinical examination, patients were divided into two groups. In the first group (n = 30), wе added to the treatment the drug voglibose (Voxid, production of Kusum Pharm Ltd, Ukraine) 0.2 mg before breakfast, lunch and dinner for 12 weeks. Results. After 12 weeks of treatment, the level of glycated hemoglobin (НbА1с) in the first group decreased by 1.5 [1.1; 1.9] % (p < 0.05), in the second group — by 0.1 [0.09; 0.6] % (p > 0.05). 80 % of patients achieved target levels of glycemia. The first group of patients showed a significant increase in HOMA-β index by 24.9 %, as well as a reduction of insulin resistance (HOMA-IR) by 31.5 %. After 12 weeks of therapy, there was a statistically significant decrease in body weight by 2.1 kg in the first group of patients and no response in patients of the second group. Safety has been proveв in terms of the functional state of the liver and kidneys in this therapy. Conclusions. Adding voglibose for intensification of therapy in patients with type 2 DM, who had previously received metformin and glimepiride, has led to a significant improvement in carbohydrate metabolism (decrease in HbA1c by 1.5 %). Better control of carbohydrate metabolism during the combination therapy with metformin, glimepiride, and voglibose is accompanied by an increase of functional activity of pancreatic β-cells, a decrease in insulin resistance in the background of weight loss.
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