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Long-acting metformin - a new step in the treatment of type 2 diabetes

Diabetes mellitus (DM) is the most common disease of the endocrine system, with a tendency to steady growth. According to the WHO, over the ten years from 2000 to 2010, the number of patients with diabetes in the world increased by 46% and amounted to 221 million people, which significantly exceeded the 2000 forecast.

Biguanides are used in medical practice for over 50 years. Leading medical organizations today recommend starting treatment for type 2 diabetes with a combination of lifestyle changes and the appointment of metformin. In this regard, of particular interest are the new results concerning the newly discovered properties of metformin.

Metformin was introduced into clinical practice for the treatment of type 2 diabetes in 1957 in Europe and in 1995 in the USA. Currently, metformin is the most commonly prescribed oral hypoglycemic agent in Europe, the USA and other countries (R. A. DeFronzo, 2007). The mechanism of the antihyperglycemic effect of metformin has been well studied. Numerous studies have shown that metformin does not affect the secretion of insulin by the beta cell, but has an extra pancreatic effect. He calls:

• decrease in carbohydrate absorption in the intestine;
• increasing the conversion of glucose into lactate in the gastrointestinal tract (GIT);
• increased insulin receptor binding;
• gene expression transporter GLUT 1 (secretion);
• increased glucose transport through the membrane in the muscles;
• transfer (translocation) of GLUT 1 and GLUT 4 from the plasma membrane to the surface membrane in the muscles;
• reduction of gluconeogenesis;
• reduced glycogenolysis;
• reducing triglycerides and low density lipoproteins;
• increased content of high density lipoproteins.

The main mechanism of action of metformin is aimed at overcoming the resistance of peripheral tissues to the action of insulin, in particular, this concerns muscle and liver tissue.

The physiological functions of the plasma membrane depend on the ability of their protein components to move freely within the phospholipid bilayer. A decrease in membrane fluidity (increased rigidity or viscosity) is often observed in experimental and clinical diabetes, which leads to the development of complications. Metformin increases the fluidity of plasma membranes in humans. Small changes in the properties of erythrocytes in individuals who previously received metformin were noted.

A number of clinical studies with different designs have been published, confirming the effect of metformin on the baked glucose metabolism.

In this study, a significant difference was obtained between the groups, proving the suppression of glucose production by the liver with the addition of metformin.

In another double-blind, randomized study, when comparing glucose production by the liver using metformin and rosiglitazone under controlled hyperinsulinemia, it was proved that metformin reliably suppresses glucose production by the liver compared to rosiglitazone.

The clinical effects of metformin, in addition to its antihyperglycemic properties, are well studied.

They were first presented after the completion of the UKPDS (United Kingdom Prospective Diabetes Study) multi-year study in 1998. The main findings were as follows:

Therapy with metformin in obese individuals reduces the risk of complications:

1. vascular complications by 32%;
2. diabetes mortality by 42%;
3. total mortality by 36%;
4. myocardial infarction by 39%.

These data were so convincing that Metformin was fully rehabilitated as a safe and useful sugar-lowering drug.

Later, numerous cardioprotective properties of metformin were proven.

It is believed that the presence of these properties explains the additional positive and prophylactic effect of metformin in type 2 diabetes.

The following are the main findings of the research of the last decade.

• Glyukofazh (metformin) has direct angioprotective effects that do not depend on the sugar-lowering effect of the drug. These effects are unique.
• Glucophage double action explains the mortality reduction results obtained in the UKPDS. Data obtained in subsequent years confirmed the positive effect of metformin. Thus, treatment with metformin compared with any other treatment was associated with lower mortality from all causes, myocardial infarction, symptoms of angina pectoris, or any case of cardiovascular manifestation.

One of the topical sections of the discussion on the effectiveness of modern trends in the treatment of type 2 diabetes is the safety of both individual sugar-lowering drugs and their combinations. Different treatment regimens were considered, one of which was the Agreed Algorithm of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes Mellitus (EASD).

Metformin is present in all treatment options. In this regard, it is advisable to consider the issue of indications and contraindications to the use of metformin, based on current available data. First, it is necessary to answer the question: why should treatment with metformin be started right from the moment a diagnosis is made, along with measures to change lifestyle? Because most people with type 2 diabetes do not lead to the achievement or maintenance of target glycemic levels, which may be due to the following factors:

• the ineffectiveness of weight loss measures;
• re-gaining body weight;
• disease progression;
• combination of these factors.

In addition to the fact that in some patients there is intolerance to the drug (according to different authors from 10% to 20%), there are also clear contraindications for prescribing metformin.

Contraindications for taking metformin:

• acute or chronic diseases that can cause tissue hypoxia (for example, cardiac or pulmonary insufficiency, myocardial infarction, shock);
• liver failure, acute alcohol intoxication, alcoholism;
• renal failure or impaired renal function (creatinine clearance <60 ml / min);
• acute conditions that can impair the function of the kidneys (dehydration, acute infection, shock, intravascular administration of radiopaque agents);
• lactation, diabetic ketoacidosis, diabetic precoma, hypersensitivity to metformin or its components.

To overcome the possible adverse effects developed special cautions when using it.

The frequency of contraindications to the appointment of metformin according to different authors is significantly different. So, according to, chronic heart failure is 87%.

One of the main reasons for concern when prescribing metformin is the risk of developing lactic acidosis in the presence of any condition accompanied by hypoxia. Lactic acidosis is a very rare, but potentially fatal complication. According to different authors, its frequency is three cases per 100,000 patients of years treated with metformin.

Lactic acidosis is clinically very dangerous. A study conducted by Stacpool PW with co-workers was performed by examining and treating 126 patients placed in intensive care units with a lactate level ≥ 5 mmol / l, in arterial blood pH ≥ 7.35 or base deficiency> 6 mmol / l During hospitalization, circulatory shock was diagnosed in 80% of these patients. Sepsis, liver failure and respiratory diseases were the main factors leading to the development of lactic acidosis. Survival after 24 hours was 59%, after 3 days - 41% and 17% after 30 days.

The cases of lactic acidosis associated with the administration of biguanides have been studied in detail. It has been reliably established that the risk of developing lactate acidosis when prescribing phenformin is 20 times higher than that when using metformin. For this reason, the use of phenformin is prohibited in most countries of the world, including in Russia. In order to prevent this terrible complication, it is necessary to carefully examine patients before prescribing the drug (see above).

The question of the possibility of using metformin in chronic heart failure (CHF) remains an important and actively discussed issue. To date, quite a lot of experience has been gained, indicating the benefits of using metformin in the treatment of patients with type 2 diabetes and heart failure. One of such studies is the work. The aim of the study was to assess the relationship between metformin intake and clinical outcomes in patients with CHF and type 2 diabetes. With the help of health databases (Canada), 12,272 patients with type 2 diabetes were treated, who received glucose-lowering drugs from 1991 to 1996. Among them, 1833 patients with CHF were identified. Monotherapy with metformin was obtained by 208, sulfonylurea derivatives (CA) - 773 and combination therapy - by 852 people.

The average age of patients was 72 g. It was 57% of men, the average duration of observation was 2.5 years. CHF was first diagnosed during hospitalization, that is, at the beginning of the study. The duration of observation was 9 years (1991–1999). Lethal outcomes: SA - 404 (52%), metformin - 69 (33%). Combination therapy - 263 cases (31%). After 1 year, the mortality rate from all causes of people who received AA was 200 people. (26%), for people who received Metformin - 29 people. (14%), in combination therapy - 97 (11%). It was concluded that metformin, both as monotherapy and as part of combination therapy, is associated with lower mortality and morbidity in patients with chronic heart failure and type 2 diabetes compared with SA.

In the British study of 2010, 8,404 patients with newly diagnosed type 2 diabetes and first diagnosed heart failure were included (from 1988 to 2007). A comparative analysis of the causes of death was carried out in two groups (1,633 deaths each). According to the results, it was concluded that when comparing individuals who did not receive antidiabetic drugs, the use of metformin was associated with a lower risk of mortality compared with other antidiabetic drugs, including even such potentially adverse factors as glycemic control, kidney function, overweight and arterial hypertension . These data are consistent with previous work, in which it was shown that people with CHF using metformin had a lower risk of death than those who used other antidiabetic drugs.

Another important and very promising direction in the study of the properties of metformin is its anti-oncogenic effect. Published a number of clinical studies in which it was shown to reduce the growth of cancer among patients using metformin.

Bowker S. L. et al. (A population retrospective cohort study using the database of the State of Saskatchewan, Canada, 1995–2006) [13]. The aim of the study was to study cancer mortality and the relationship with antidiabetic therapy for type 2 diabetes. A total of 10,309 patients with type 2 diabetes with newly prescribed metformin, sulfonylurea derivatives (CA) and insulin were examined. The average age of patients was 63.4 ± 13.3 years, among them 55% were men. Metformin was prescribed to 1229 patients in the form of monotherapy, PSM - to 3340 patients in the form of monotherapy, combined therapy - 5740, 1443 - insulin was added. Duration of observation - 5.4 ± 1.9 years.

Total cancer mortality was 4.9% (162 of 3340) in patients who received CA, 3.5% (245 of 6969) metformin, and 5.8% (84 of 1443) insulin. The data presented by Bowker demonstrate a twofold increase in the incidence of cancer in the group of patients on insulin therapy relative to the group of metformin 1.9 (95% CI 1.5-2.4, p <0.0001). In the group of patients treated with CA drugs, the risk of cancer was also significantly higher than in the metformin group and was 1.3 (95% CI 1.1–1.6, p = 0.012).

Currie C. J et al. also studied the risk of developing malignant tumors in patients with type 2 diabetes depending on the type of therapy. The study included 62 809 patients with type 2 diabetes older than 40 years, who were divided into four therapeutic groups: metformin monotherapy or SA, metformin combination therapy and SA, and insulin therapy. The group of patients receiving insulin was divided into subclasses: monotherapy with insulin glargine, NPH insulin, biphasic insulin and its analogues. Also, data on the manifestation or progression over the period of treatment (insulin therapy since 2000) of any malignant tumors were assessed; Special attention was paid to breast cancer, colon, pancreas and prostate cancer.

When analyzing the data obtained, it was found that in the group of patients receiving metformin, there was a significant reduction in the risk of developing colon and pancreatic cancer (however, no similar pattern was observed with respect to prostate and breast cancer). Reducing the growth of malignant cells against metformin monotherapy was 0.54 (95% CI 0.43–0.66). Even if metformin was added to any glucose-lowering therapy, the risk of malignancy was reduced to 0.54 (95% CI 0.43–0.66).

Results and conclusion

Metformin monotherapy was associated with the lowest risk of cancer. For comparison, the relative risk (RR) was:

1. for metformin + PSM - 1.08;
2. for monotherapy PSM - 1,36;
3. when using insulin - 1.42;
4. adding metformin to insulin - 0.54;
5. compared to metformin, insulin therapy increased the risk of colorectal cancer (RR 1.69) and pancreatic cancer (RR 4.63);
6. insulin therapy did not affect the risks of prostate and breast cancer.

One of the latest published studies is the ZODIAC-16 study (Zwolle Outpatient Diabetes project Integrating Available Care), completed in the Netherlands and published in 2010. The aim of the study was to study the association between the specific treatment of type 2 diabetes and cancer mortality. In this case, the association between metformin use and cancer mortality in a prospective cohort was studied. Patient recruitment was conducted from 1998 to 1999. 1353 patients with type 2 diabetes were included. The study was completed in 2009. Patient characteristics:

• on metformin - 289;
• without metformin - 1064;
• mean age 67.8 ± 11.7 years;
• the duration of diabetes is 6.0 years;
• BMI - 28.9 ± 4.8 kg / m2;
• HbA1c - 7.5 ± 1.2%;
• SKF - 73.9 ± 28.1 ml / min;
• insulin therapy - 16.5%;
• SA — 55.0%;
• diet (only) - 13.0%;
• Persons with active cancers, cognitive impairment and a very small life expectancy are excluded.

When evaluated after 9.6 years, only 570 patients died (42%). Of these, 122 (21%) died of cancer, among them 26 (21%) of lung cancer, 21 (17%) of abdominal cancer. 238 patients (41%) died from cardiovascular diseases. The causes of death of 541 (94%) patients are known. In patients treated with metformin, compared with patients not treated with metformin, the OR of cancer mortality was 0.43 (95% CL 0.23–0.80). RR increased with increasing dose of metformin — at the addition of each gram of metformin, RR was 0.58 (0.95% CL 0.36–0.93).

It is worth mentioning that the administration of metformin in polycystic ovary syndrome, characterized by IR and acting as a risk factor for the development of uterine cancer, also contributes to the leveling of possible atypical endometrial hyperplasia. Of undoubted interest are the studies of Russian scientists in which the biguanides, along with lipid-lowering drugs and diet, were prescribed for a long time to more than 300 patients with breast and colon cancer undergoing surgical treatment. As a result, by 3–7 years of observation, an increase in cumulative survival was found, as well as a slight decrease in the frequency of detection of primary multiple tumors and metachronous tumors of the second mammary gland.

One of the current trends in the study of the possibilities of other uses of metformin is work related to the possibility of treating non-alcoholic fatty liver disease (NAFLD). Non-alcoholic fatty liver disease is a common chronic liver disease characterized by an abnormal accumulation of fat drops, not associated with alcohol consumption. NAFLD is a component of metabolic syndrome, type 2 diabetes, obesity. NAFLD may be referred to in the literature by different names: non-alcoholic Laennek disease, “fatty liver” hepatitis, diabetic hepatitis, alcohol-like liver disease, non-alcoholic steatohepatitis. Steatohepatitis is a stage in the development of non-alcoholic fatty liver disease. The diagnosis of NAFLD is made on the basis of asymptomatic increase in aminotransferase levels, the unexplained existence of persistent hepatomegaly, which is confirmed by radiological research, provided that all other causes leading to hepatomegaly are excluded (alcohol, drugs, lack of protein nutrition, toxic mushrooms, organic solvents, etc.).

The only reliable diagnostic criterion is a liver biopsy. It is the lack of available non-invasive diagnostic methods that explains the small amount of work devoted to the study of the pathogenesis and effectiveness of treatment of NAFLD. The diagnosis can be confirmed by the following laboratory data: an increase in the level of aspartate aminotransferase (AST), an increase in the level of alinine aminotransferase (ALT), an increase in enzymes by more than 4 times. ALT> AST; alkaline phosphatase is increased by more than 2 times compared to the norm. The course of NAFLD can be benign and malignant. In the second case, there is an outcome in cirrhosis and liver failure or in hepatocellular carcinoma.

It has been established that target tissues for drugs that reduce the resistance of peripheral tissues to insulin are different. So, thiazolidinediones (TZD) act mainly at the level of muscle and adipose tissue, and metformin to a greater extent at the level of the liver. Therefore, for the treatment of NAFLD, it is primarily advisable to use metformin.

In the near future, a new dosage form of metformin, Glucofage Long, will appear in clinical practice in Russia. This form of prolonged action drug is designed to overcome such side effects as disorders of the gastrointestinal tract, simplify the regimen of administration of the drug for the elderly, to increase compliance and preserve the effectiveness of the treatment. This drug has been successfully used in European countries and is included as a starting therapy in the clinical guidelines of several countries. The drug has been tested in international multicenter studies and has proven its effectiveness and safety.

The extension system is called GelShield and consists of an external and internal polymer matrix.

After an oral dose in the form of a tablet of prolonged action, the absorption of metformin is slower compared with a tablet with the usual release of metformin. The time to reach the maximum concentration (TCmax) is 7 hours. At the same time, TCmax for a tablet with a normal release is 2.5 hours. After a single intake of 2000 mg of metformin in the form of tablets with prolonged action, the area under the concentration / time curve (AUC) is similar to that observed after taking 1000 mg of metformin in the form of tablets with regular release twice a day. The fluctuations of the maximum concentration of metformin (Cmax) and AUC in individual patients in the case of taking metformin in the form of tablets of prolonged action are comparable with the same indicators as in the case of taking tablets with a normal release profile.

Absorption of metformin from sustained release tablets does not change depending on the meal. Not observed cumulation with repeated use of up to 2000 mg of metformin in the form of tablets with prolonged action.

Dosage and administration

The drug Glyukofazh® Long of the prolonged action is prescribed inside. The tablets are swallowed without chewing, during dinner (1 time per day) or during breakfast and dinner (2 times a day). Tablets should be taken only with meals.

The dose of the drug is selected by titration from minimal to effective therapeutic (maximum) for 10-15 days, depending on the target values ​​of glycemia. It is possible to conduct both monotherapy and combination therapy with other hypoglycemic agents.

The usual initial dose - Glucophage Long 500 mg: 1 tablet 1 time per day during dinner. When switching from metformin with the usual release of the active ingredient to Glucofage Long, the initial dose of Glucofage® Long should be the same as the daily dose of metformin with the usual release of the active ingredient.

The maximum daily dose of Glyukofazh Long of the prolonged action makes 2000 mg once a day during a dinner. If glucose control is not achieved with a maximum daily dose taken 1 time per day, then you can consider splitting this dose into two doses per day according to the following scheme: Glucophage Long-acting 500 mg: 2 tablets during breakfast and 2 tablets per dinner time. Abroad, the drug Glucophage® Long is available in dosages of 500, 750 and 1000 mg in 1 tablet. In Russia, it is still presented with a dosage of 500 mg per 1 tablet.

In conclusion, it is necessary to emphasize that metformin is one of the oldest drugs and many of its properties are well studied, however, this drug rightfully occupies a leading position in the treatment of type 2 diabetes. Clinical research is ongoing, and many of its new beneficial properties may be discovered.

How to treat type 2 diabetes

Type 2 diabetes mellitus is an endocrine pathology caused by insufficient production of insulin of its own by the pancreas and decreased tissue sensitivity to it. When a disease is diagnosed, the patient’s treatment immediately begins to prevent the development of numerous complications. Therapy for type 2 diabetes mellitus is based on taking pharmacological drugs, dieting, increasing motor activity. An indispensable condition for successful treatment is the continuous measurement of the level of glucose in the blood, and sometimes in the urine. Many patients wonder if they can cure type 2 diabetes. So far, the pathology cannot be finally defeated, but it is possible for each patient to prevent its progression.

The right approach to treatment

The question of how to cure non-insulin-dependent type 2 diabetes forever is often heard at an endocrinologist’s office. While it is impossible to cope with the disease, one can only slow down the development of undesirable consequences. At present, effective pharmacological preparations of various actions have been synthesized, for example, capable of quickly removing glucose from the body when the bladder is empty.

Perhaps there is no person who would not hear about diabetes. And everyone hopes that it will bypass the disease. The main causes of pathology are:

• heredity;
• excess weight.

And if nothing can be done with a genetic predisposition, the treatment of diabetes always begins with a decrease in the patient's body weight. The following methods are used for this:

• observance of low-calorie and low-carb diets;
• increase in motor activity.

After normalization of weight, proper nutrition and moderate exercise allow you to adjust the level of glucose in the systemic circulation. But without taking antidiabetic drugs rarely costs. They are appointed in the following cases:

• with the development of complications;
• when raising the level of sugar, even during a diet.

Only the endocrinologist chooses drugs, taking into account many factors: the patient's age, the results of laboratory tests, the presence of concomitant diseases, the number of complications that have arisen. Sometimes even modern preparations do not help to reduce the level of sugar. In this case, the patient is given injection solutions of insulin. Only narrowly specialized doctors and endocrinologists know how to treat type 2 diabetes. Therapy with self-selected drugs will cause the development of severe complications.

The need for self-control

Another condition for the normalization of glucose in the bloodstream is its regular measurements and recording of the results in a diary. In most hospitals, patients are given free blood glucose meters, as well as test strips and scarifiers for piercing a finger. If for some reason a compact device is not suitable for a specific person, then you can purchase the device at a medical equipment store or a pharmacy. When diagnosing type 2 diabetes, a person should measure blood sugar levels 2 times a day.

Self-control allows you to solve the following tasks:

• normalize metabolic processes;
• prevent the development of complications;
• if necessary, quickly reduce the level of glucose by administering insulin or antidiabetic pills.

In severe illness, the frequency of measurements can be increased. At the beginning of treatment, inexperienced patients have difficulty calculating the caloric content of food, which certainly affects the level of sugar. Therefore, endocrinologists explain to patients that some internal and external factors should be taken into account during measurements. These include:

1. increased physical activity;
2. introduction to the diet of new products;
3. unstable psycho-emotional state;
4. replacement of antidiabetic drugs with analogues or drugs similar in pharmacological action.

In some cases, doctors prescribe patients to measure the level of sugar not only in the blood, but also in the urine. As a rule, glucose is detected in urine with the help of special test strips in case of non-compliance with a therapeutic diet or the ineffectiveness of antidiabetic drugs. On the appearance of sugar in the urine should immediately notify the endocrinologist for the correction of a dangerous condition. Diabetes mellitus is not treated with folk remedies, but they can be used as an auxiliary therapy.

Physical activity

Doctors recommend moderate physical activity in almost all diseases due to their positive effect on the human body. But in the treatment of type 2 diabetes, moderate motor activity is one of the effective ways to reduce glucose in the systemic circulation. When selecting the type and mode of training, the attending endocrinologist takes into account the age and general health of the patient. In the presence of already developed complications, the following loads are recommended:

• walks;
• yoga;
• physiotherapy.

In the treatment of diabetes practiced the appointment of moderate exercise, during which performed the same type of movement. Before conducting training and after their termination, the patient must necessarily measure the level of glucose, blood pressure and the frequency of contractions of the heart muscle. Increased motor activity favorably affects the well-being of a person for the following reasons:

• Accelerated utilization of glucose in the body. Lowering the level of sugar in the bloodstream occurs not only during training or walking, but also after 2-3 hours after their completion. Moderate physical activity allows cholesterol blocks to be removed from large and small blood vessels. At the same time, the content of beneficial triglycerides, which are necessary for the functioning of all vital systems, is significantly increased.
• Reduced blood viscosity. In patients with diabetes mellitus, the main cause of the development of complications is blood clots, impeding its circulation through the vessels. Impaired blood circulation provokes a deficiency of molecular oxygen, nutrient and biologically active substances in the tissues. Eliminate the pathological condition will help physical therapy, swimming, walking in the nearest park. The blood liquefies, preventing platelet aggregation.
• Dangerous for human life complications of type 2 diabetes are heart attack and stroke. High motor activity in conjunction with proper nutrition will be an excellent prevention of violations of the heart and cerebral circulation. After a few months of regular classes, the blood sugar level normalizes as a result of the positive effect of training on the myocardium:
• blood pressure decreases;
• heart muscle ceases to experience oxygen deficiency;
• improved neuromuscular conduction;
• the amount of blood released by the heart into the vessels per unit of time increases;
• normal heart rate.

Physical activity can stabilize the optimal state of hormonal levels. Stress hormones adrenaline and cortisol begin to be produced in smaller quantities, but the level of endorphins in the systemic circulation increases significantly. Regular exercise has a positive effect on the psycho-emotional state of the patient, which affects the level of sugar. The human body becomes more susceptible to insulin produced by the pancreas.

Therapeutic diet

Despite the fact that endocrinologists give a negative answer to the question of whether it is possible to cure type 2 diabetes, we should not panic. Prolonged exposure to a stressful situation will only increase the level of glucose, and it must be reduced. Dieting is an essential part of the treatment of metabolic disorders. If the patient is eating right, then it is very noticeable by the results of laboratory tests. In such cases, the endocrinologist may reduce the dosage of antidiabetic drugs that exhibit a large number of side effects. And at the initial stage of the disease, a balanced daily menu allows you to do without taking pills or insulin injections.

Basic rules of nutrition

Experienced endocrinologists know from their own experience that a person with diabetes will live a long and happy life, only preferring low-carb foods. Even taking the most expensive modern drugs will not prevent the loss of cell sensitivity to insulin if there are fried or sweet foods on the patient's table. What do endocrinologists recommend to their patients:

1. limit the total caloric intake while maintaining its energy value;
2. eat at the same time 5-6 times a day to normalize the metabolism and the gastrointestinal tract;
3. all carbohydrates to eat in the morning, but the energy component of all servings should be about the same;
4. introduce new foods into the diet, do not get hung up on the same dishes;
5. add fresh, fiber-rich vegetables to each dish to reduce the absorption rate of simple sugars;
6. Allowed sweets (diet mousses, jellies, marmalade) are eaten as desserts after breakfast or lunch, without using them as snacks between meals;
7. minimize or completely eliminate when cooking dishes salt, spices and spices.

The diet of the patient with diabetes should be low-fat fish, lean meat, dairy products, fresh and boiled vegetables, clear broths. If a person does not have diseases of the urinary system, then during the day it is necessary to drink at least 2.5 liters of pure non-carbonated water, chamomile tea, cranberry juice.

Dietary restrictions

It is impossible to cure non-insulin-dependent diabetes mellitus, but only proper nutrition will minimize or prevent its consequences. Of course, the habitual way of life of a person will change a lot, which often has a positive effect on a person’s well-being. Refusal to smoke and consume alcoholic beverages, fatty, smoked, fried foods always has a beneficial effect on overall health. What else endocrinologists can recommend to their patients:

• do not skip breakfast, do not take long breaks between meals;
• should not eat hot or cold dishes;
• It is strictly forbidden to bread and fry meat, vegetables or fish;
• food must be chewed thoroughly for better absorption.

Many people with diabetes mellitus use artificial sweeteners in tablets or powders for cooking. Endocrinologists recommend to refuse such a way to improve the taste of dishes. According to clinical trials, the use of artificial sweeteners can cause a sharp rise in the level of sugar in the systemic circulation. It is much safer to eat a teaspoon of flower honey. Pharmacies sell stevia medicinal plant, packaged in filter bags. When brewing herbs, an infusion is obtained with a pronounced sweet taste and healing effect. Regular consumption of such a drink will not only make a variety of the diabetic patient’s diet, but also lower the level of glucose in the blood.

Do not use animal fats, spread, margarine, mayonnaise, soy sauce when cooking. Also banned are the following foods:

• smoked meat, fatty meats and fish;
• cereal porridge;
• rich soups, borscht;
• halva, butter and puff pastries, chocolate, custard and butter cream;
• potatoes, carrots, beets;
• dried fruits, bananas, other sweet fruits and berries;
• whole milk, fat cheeses, cream.

The level of sugar in the blood will not rise, if the products are boiled, baked, let in a small amount of water, steamed. The whole point of dieting in the treatment of type 2 diabetes is to return the sensitivity of specific cells to insulin. Therefore, it is erroneous to assume that a couple of slices of chocolate or a small package of chips will not cause serious damage to the body. This neglect of medical recommendations will negate the effect of even modern pharmacological drugs.

Drug treatment

Before treating diabetes mellitus type 2, endocrinologists try to reduce the level of glucose in the systemic circulation using proper nutrition and moderate exercise. And only making sure that this method is not effective, antidiabetic agents are prescribed. Practice the use of drugs that have a complex effect on the human body:

• they stimulate the secretion of insulin by beta cells of the pancreas, remove harmful lipids from the body, retain useful triglycerides in blood vessels, decrease tissue resistance to insulin;
• inhibit the synthesis of simple sugars and slow down their absorption from the intestine into the systemic circulation.

Treatment of diabetes of the second type begins with the admission of a single component.

With its ineffectiveness, endocrinologists prescribe to the patient the use of combined drugs or a combination of several medicines. And only in the absence of a positive result of these methods for treating endocrine pathology, insulin injections are applied.

Sulfonyl Urea Derivatives

Most of the preparations were synthesized several decades ago, but so far they are characterized by high antidiabetic efficacy. These drugs include:

• Glibenclamide;
• Glimepiride;
• Tolbutamide;
• Chlorpropamide.

Regular consumption of sulfonylurea derivatives leads to an increase in beta cell secretion by the pancreas, which produce insulin of their own. The resistance of peripheral tissues to it also gradually decreases. Antidiabetic agents from this group are quite well tolerated by patients, and only in some cases there is a likelihood of hypoglycemia, or a sharp decrease in the sugar content in the bloodstream.

Biguanides

Usually, first-choice drugs that help cure type 2 diabetes become pharmacological drugs from the biguanide group. Their active ingredient is Metformin, which prevents peripheral tissue insulin resistance. There are many structural analogues of this antidiabetic compound:

• Glucophage;
• Bagomet;
• Glyminfor;
• Gliformin;
• Siofor;
• Formetin;
• Glycon.

Taking drugs with Metformin inhibits the absorption of sugar from the intestine and gluconeogenesis in hepatocytes. The drug does not affect the production of beta cells, is not able to provoke hypoglycemic reactions. The undoubted advantage of drugs with Metformin is the stabilization of the patient's body weight. At the beginning of treatment may develop dyspeptic disorders (nausea, diarrhea, vomiting), which gradually disappear. The drugs are not prescribed for serious complications that have already developed, especially with a decrease in the functional activity of the organs of the urinary system.

SGLT2 Inhibitors

In the treatment of type 2 diabetes used drugs last generation Forsig and Invokan. The principle of action of these drugs is to reduce the reverse absorption of sugar into the bloodstream from the kidneys. In a patient with diabetes, an excessive absorption of glucose occurs with insufficient elimination. The use of SGLT2 inhibitors allows blocking such a mechanism for transporting simple sugars, facilitating their evacuation with each emptying of the bladder. Antidiabetic agents do not provoke a hypoglycemic state and do not affect the main metabolic processes. Contraindications to the treatment of these drugs is the period of childbearing, old age and serious pathologies of the liver and kidneys.

Not all patients adhere to the diet, considering that pharmacological drugs will cope in any case. This is a widespread misconception that adversely affects the results of therapy. Despite the fact that diabetes mellitus is still incurable, proper nutrition and physical activity will help a person to lead an active lifestyle.