The Influence of Natural, Preformed Physical Factors in Patients with Type 2 Diabetes Mellitus with the Metabolic Syndrome on the Compensation of Carbohydrate Metabolism According to the Results of Continuous Glucose Level Monitoring

Abstract

In recent years, rehabilitative and preventive areas of medicine have become relevant. Restorative treatment and rehabilitation with the use of complex resort therapy in patients with type 2 diabetes have been relevant in recent years. The purpose of our study was to investigate the variability of glycemia in patients with type 2 diabetes mellitus with MS under the influence of natural and preformed physical factors at the sanatorium of SPK "Morshinkurort" in Morshin. Continuous glucose monitoring (CGM) was performed using the Metronic Guardian Connect system in 48 patients with type 2 diabetes and MS for an average of 14 days before and after treatment. Daily monitoring of blood glucose was carried out using the "Metronic" device. We used traditional indicators of glycemia variability according to the recommendations of the American Diabetes Association. All patients with type 2 diabetes and MS had signs of abdominal obesity, which was evidenced by an increase not only in BMI, but also in OT. Their waist circumference was 112.06±5.59 in men and 107.64±2.46 in women. After the course of treatment, the NOMA IR index decreased by 3 times (p<0.05). The content of fasting insulin in the blood after 3 months of treatment probably decreased by 45%, which indicates a significant contribution of sanatorium-spa therapy in overcoming hyperinsulinemia and insulin resistance in general. For optimal diabetes control, in addition to HbA1c, we must consider CGM and % Time in range (TIR) ​​(time in target range). TIR: (3.9–10.0 mmol/l) in the studied patients before treatment was 53.30±5.90% and significantly differed from patients after treatment - 72.53±7.41% (p < 0.05 ) (with a norm of >70%). TIR should be used as a target point as an indicator of glycemic control in routine clinical practice. Under the influence of natural and preformed physical factors in the conditions of the "Morshinkurort" medical center in Morshyn, in patients with type 2 diabetes with MS, the variability of glycemia according to CGM data is likely to decrease, which makes it possible to achieve strategic goals and criteria for the effectiveness of treatment of diabetes. CGM plays an important role in evaluating the effectiveness and safety of treatment, including the prevention of hypoglycemia.