PECULIARITIES OF CARBOHYDRATE METABOLISM INDICATORS, THE FUNCTIONAL STATE OF THE THYROID GLAND IN THE COURSE TREATMENT WITH TELMISARTAN AS PART OF THE COMPLEX THERAPY OF PATIENTS WITH CORONARY ARTERY DISEASE, TYPE 2 DIABETES MELLITUS ON THE BASIS OF METAB

Abstract

Aim. Is to study the characteristics of carbohydrate metabolism indicators, the functional state of the thyroid gland in the course treatment with Telmisartan as a part of the complex therapy of patients with Coronary Artery Disease, type 2 Diabetes Mellitus on the basis of Metabolic Syndrome.
 Materials and Methods. Research design. The first stage - formation of groups (the experimental group and the comparison group). The experimental group consisting of 27 patients (13 men and 14 women), taking Telmisartan 80 mg/day as a part of complex therapy (Metformin, Amlodipine, Rosuvastatin, Acetylsalicylic acid, and Nitroglycerin as needed). The comparison group consisting of 24 patients (12 men and 12 women) taking Ramipril, 5 mg/day in addition to the standard therapy, mentioned above. At the second stage, the patients were examined for carbohydrate metabolism and Thyroid-stimulating hormone and free Thyroxine. At the third stage, patients were prescribed the treatment for 1 month. The dose of metformin did not change during the study. Re-examination of hormones and carbohydrate metabolism parameters one month after the start of therapy was carried out at the fourth stage. The control group consisted of 40 practically healthy people (17 men and 23 women). The work involved researching the carbohydrate spectrum parameters as well as the followings hormones: free Thyroxine and Thyroid-stimulating hormone, control of blood pressure parameters. The Patients were examined twice, on the day of admission to inpatient treatment and after 1 month. According to the results of the obtained data, the studied groups were compared with each other, as well as with a group of healthy individuals.
 Results and Discussion. The study compared the dynamics of blood pressure parameters, indicators of carbohydrate metabolism, Thyroid-stimulating hormone and Free thyroxine in patients with Coronary Artery Disease and compensated type 2 Diabetes Mellitus on the basis of Metabolic Syndrome, depending on their intake of Telmisartan or Ramipril against the background of standard therapy, which included: Metformin, Amlodipine, Acetylsalicylic acid. In the group taking Telmisartan as part of complex treatment, a decrease in clinical manifestations of syntropic pathology was found, and the presence of positive dynamics of diastolic blood pressure indicators was noted even after 1 month of treatment. Patients experienced a decrease in the frequency of angina attacks, reduced shortness of breath, palpitations during exercise, headaches, dizziness, anxiety, improved attention and memory. The results of our study show taking Telmisartan as a part of complex therapy contributed to changes in the parameters of carbohydrate metabolism such as fasting blood glucose, insulin level, HOMA-IR index decreased significantly, which can be explained by a decrease in insulin resistance at addition Telmisartan to the complex treatment. In contrast to the mentioned above parameters, indicators of glycosylated hemoglobin after 1 month treatment did not change significantly, which can be explained by the insufficient duration of treatment. In the patients of the experimental group, it was found that the level of Thyroid-stimulating hormone significantly decreased during treatment with Telmisartan as part of complex therapy, in contrast to the comparison group, taking Ramipril at the same time. The level of free Thyroxine in patients with experimental group increased a month after start of therapy, while it remained unchanged in patients with comparison group.
 Conclusions. The effectiveness of correction of diastolic blood pressure parameters, the presence of peculiarities of changes in carbohydrate metabolism and thyroid functional state when Telmisartan is used as part of the complex therapy of patients with Coronary Artery Disease and compensated type 2 Diabetes Mellitus on the basis of Metabolic Syndrome. The use of Telmisartan as part of complex treatment reduces insulin resistance; helps to reduce the level of fasting blood glucose, values of the HOMA-IR index, as well as the amount of insulin in the blood. The use of Telmisartan in patients with Coronary Artery Disease and type 2 Diabetes Mellitus on the basis of Metabolic Syndrome aids in reducing the level of Thyroid-stimulating hormone and increase in free Thyroxine (within the reference values), confirming participation in the correction of metabolic changes.