Эффективность и безопасность разных режимов cахароснижающего лечения у лиц с синдромом раздраженного кишечника в сочетании с сахарным диабетом 2 типа

Abstract

Among the disorders associated with type 2 diabetes mellitus, intestinal functional changes (irritable bowel syndrome — IBS) are an insufficiently studied problem. The purpose — a prospective study of the efficacy and safety of various hypoglycemic treatment regimens in patients with IBS and type 2 diabetes mellitus. Material and methods The study included 107 patients aged 48.9 ± 9.4 years with type 2 diabetes mellitus and clinical manifestations of IBS, who were divided into 4 groups depending on the prescribed hypoglycemic therapy: patients of group A received metformin, group B — a combination of metformin with saxagliptin, group C — a combination of metformin with liraglutide or exenatide, group D — combination of metformin with dapagliflozin. The duration of the study was not less than 5 months. Results. Treatment in all groups resulted in a significant decrease in the average values of HbA1c, fructosamine, insulin, C-peptide and the HOMA-IR index, an increase in the values of the NOMA-B index, p < 0.05. A more significant absolute and relative decrease in the levels of HbA1c, insulin and HOMA-IR index was observed in groups C and D in comparison with groups A and B. The use of various classes of hypoglycemic drugs in people with IBS and type 2 diabetes mellitus was characterized by satisfactory tolerability and was associated with a significant decrease in clinical manifestations of constipation, diarrhea, abdominal pain, gastroesophageal reflux, and a positive effect on glycemic levels. The criteria for predicting the effectiveness and safety of hypoglycemic treatment in patients with a combination of IBS and type 2 diabetes mellitus were the diabetes duration < 7 years, the values of HOMA-IR <5 and NOMA-B ³ 60, the absence of smoking, the uric acid concentration in blood < 350 mmol/ l, the absence of hypothyroidism and the choice of dapagliflozin as a component of hypoglycemic therapy.