Медицинский совет (May 2020)
Possibilities of using continuous glycemic monitoring to assess the effectiveness of therapy in patients with MODY-diabetes
Abstract
Verification of the type of diabetes mellitus in young people is of high clinical significance in the clinical practice since the purpose of treatment depends on this: from the correction of carbohydrate metabolism by a rational diet to the administration of oral hypoglycemic drugs and insulin therapy. The chosen therapy has a significant impact on the quality of life of the patient. With the most common types of diabetes in young people the appointment of therapy is not in doubt, since with type 1 diabetes mellitus there is an absolute need for the maintenance of exogenous insulin, and with type 2 the administration of metformin is pathogenetically substantiated. In more rare forms of diabetes which MODY belongs to sulfonylurea preparations are recommended in most cases and there are few conflicting data on the effects of newer classes (DPP4, SGLT2 inhibitors, GLP1 agonists) with monogenic forms. Using the method of continuous monitoring of glucose (CGMS) and glycemic variability indicators it is possible to determine the effectiveness of various classes of sugar-lowering drugs for rare types of diabetes mellitus which will help practitioners in choosing therapy. In the literature single studies using CGMS have been described in this group of patients. In Turkey CGMS was performed for 8 patients with GCK-MODY; it was shown that in 50% of patients the glucose values during the day exceeded the normal ranges. Italian scientists conducted a study in which they diagnosed glycemic variability, in particular episodes of hypoglycemia, in patients with HNF4AMODY diabetes (MODY1) using CGMS. The clinical consequence of episodes of asymptomatic hypoglycemia in the MODY cohort remains unknown. Diagnosing the predominance of fasting or postprandial hyperglycemia, the determination of hypoglycemia can help in the appointment of pathogenetic therapy and improve the quality of life of people diagnosed with MODY-diabetes.
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