Pros and Cons of Using a Combination of Glow-Lowing Drugs, In Particular Dpp-4 Inhibitors and Metformin in Patients with Type 2 Diabetes and Overweight
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Relevance. In practice, when prescribing therapy, it is important to find a balance between the optimal glucose-lowering activity of the drug and a favorable safety profile in relation to body weight. In recent decades, new classes of drugs have emerged for the treatment of T2DM that do not affect body weight or even reduce it. Also, the arsenal of therapy for the treatment of obesity has been replenished with drugs that combine the ability to reduce body weight and compensate for carbohydrate metabolism. The article presents data on modern therapy for obesity and T2DM and options for optimal therapeutic combinations. The beginning of the new millennium was marked by an epidemic of non-communicable diseases. Since the 1980s The prevalence of obesity has doubled, and type 2 diabetes mellitus (T2DM) has increased by almost 2.5 times. The number of people with metabolic disorders continues to progressively increase, significantly exceeding all existing expert forecasts [1]. There are several possible explanations for this: first, increased food availability has led to a significant increase in average daily caloric intake (in the United States, this indicator increased by 24.5%, or ~530 calories between 1970 and 2000) [2]; secondly, a change in diet with an increase in the consumption of refined carbohydrates, sugar, animal and vegetable fats and a decrease in the consumption of fruits, vegetables and legumes; thirdly, due to the mechanization of labor and the development of transport, energy costs have significantly decreased; fourthly, thanks to the improvement of clothing and heating systems, the importance of adaptive thermogenesis has decreased [3]. At the same time, the contribution of genetic factors to the development of obesity should not be overestimated: it is only about 20%; the development of the pandemic of metabolic disorders is mainly due to environmental factors [4]. About 80% of patients with T2DM are overweight or obese. It has been proven that obesity and T2DM are closely related pathogenetically. Data from extensive epidemiological studies confirm the role of excess body weight in the development of carbohydrate metabolism disorders [10]. Timely weight loss not only slows the progression of prediabetes to diabetes, but also leads to improved glycemic control and a reduced need for glucose-lowering drugs in T2DM. Weight loss is most effective in the early stages of T2DM, when β-cell dysfunction is still reversible [5].
Keywords
DPP-4, metformin, type 2 diabetes mellitus, GFR, overweight, obesity