Эффективность и безопасность использования метформина у больных с сахарным диабетом, развившимся на фоне панкреатита

Abstract

Pancreatogenic diabetes mellitus (DM-P) is a topical multidisciplinary problem, many aspects of which need further research. The purpose is to study the efficacy and safety of metformin as a component of hypoglycemic therapy in patients with DM–P in prospective follow-up. Material and methods. The study included 81 patients with DM-P aged 54.7 (9.3) years, with a history of pancreatic lesions from 5 months to 4.5 years. In group A (n = 37), insulin preparations were used as hypoglycemic agents, in group B (n = 44) metformin (at HbA1c levels > 8% and fasting glycemia > 10 mmol/l insulin preparations were added to it). The follow-up was 10.6 (2.7) months. Results. Initially, hypoglycemic treatment as metformin monotherapy was prescribed to 43.1% patients of group B, that insured adequate glycemic control in 27.3% of cases. During treatment, the average HbA1c levels decreased in group A from 9.8 (1.9) % to 8.6 (1.6) %, in group B — from 9.4 (1.8) % to 8.1 (1.4) %, respectively, p < 0.05. In group B, the proportion of people who achieved the target levels of HbA1c was significantly higher (61.3%) than in group A (35.1%), p < 0.05. The addition of metformin to insulin preparations in group B allowed reducing the insulin dose by ≥ 20% in 36% of patients. The treatment tolerability in both groups was satisfactory. The development of episodes of grade 1–2 hypoglycemia was noted in 20 (54.0%) and 18 (40.9%) patients in groups A and B; grade 3 — in 6 (16.2%) and 6 (13.6%), respectively, p > 0.05. The development of gastrointestinal effects of metformin was noted in 29.5% of patients and was transient. Conclusions. The use of metformin in DM-P as monotherapy or in combination with insulin preparations was satisfactorily tolerated, contributed to improved glycemic control, allowed reducing insulin doses, and was associated with a decrease of pancreatitis recurrence.