Mìžnarodnij Endokrinologìčnij Žurnal (Sep 2020)
Type 2 diabetes mellitus: current international guidelines, personalized approach and real outpatient practice
Abstract
According to experts from the International Diabetes Federation, the total number of people with diabetes mellitus (DM) will increase from 463 million in 2019 to 578 million in 2030 and to 700 million in 2045. In the context of the COVID-19 pandemic, patients with type 2 DM are more vulnerable to infection and severe pathology. Approaches to the choice of antihyperglycemic therapy to achieve ideal glycemic status are changing, given the emergence of new data on the pathogenesis of DM complications. Nowadays, the concept is adopted about individualization of antihyperglycemic therapy, i.e. the selection of treatment regimens based on information about a particular patient, the course and risk of developing diabetic complications. Given the increase in the proportion of elderly people, the treatment of type 2 DM in this age group is one of the important medical and social problems. Antihyperglycemic therapy in this population is difficult due to the increased risk of hypoglycemia, the presence of multiorgan and comorbid pathology, which significantly affects the course of type 2 DM. The literature review considers the issues of adequate prescription of drugs, in particular dipeptidyl peptidase-4 inhibitors. The presence of the expected hypoglycemic effect without the risks of hypoglycemia, good tolerability, favorable cardiovascular potential allows their widespread use in the elderly and senile patients with type 2 DM. The focus of the review is made on the VERIFY study that found that early combination therapy with vildagliptin and metformin reduces the risk of glycemic control loss by 49 %, exceeds the strategy of gradual intensification, provides stable control of glycated hemoglobin for 5 years, ensures its consistently low level, which is especially important in the first year of therapy to slow the progression of type 2 DM complications. Therefore, early combination therapy with vildagliptin and metformin in patients with type 2 DM has advantages over the strategy of gradual intensification.
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