Effects of Teraphy with Basal Insulin Analogues Combined with GLP 1 Analogues and Metformin in the Treatment of Obese Patients with Poorly Regulated Postprandial Glycemia

ABSTRACT Introduction: Patient-oriented therapy represents a modern approach in the treatment of patients with diabetes, an approach which is supported in the most recent guidelines by the ADA and the European Association for the Study of Diabetes (EASD). The progressive nature of diabetes demands the introduction of insulin therapy much earlier in order to prevent the development of late complications of the disease. Material and methods: The study included 30 patients who had been treated with long-acting insulin analogue and metformin in doses of 3 x 850 mg at least 6 months prior to study entry and in which a good glycaemic control had not been achieved, or with HbA1c > 7%. Patients who had a BMI > 28 kg /m2 were included in the study. Results and discussion: At the beginning of the study the patients were switched to combined therapy with long-acting basal analog, metformin and liraglutide in a dosage of 0.6 mg of 1x1. After 12 weeks of the new therapeutic regimen we recorded a significant reduction in the parameter levels that we monitored in the study. BMI value after the test was 28.2±1.39 kg/m2, p=0.025, HbA1c 7.24±0.47%, p=0.030, fasting blood glucose level 7.04±0.32 mmol/l, p=0.023, postprandial glucose level 7.6±0.46 mmol/l, p=0.012, systolic blood pressure level 123±5.75 mmHg, p=0.015, diastolic blood pressure level 79.1±2.91 mmHg, p=0.03. During research that we have conducted over 12 weeks, a reduction of body weight was achieved while improving the value of parameters significant for the study. Conclusion: There was a significant lowering of HbA1c, fasting blood glucose levels, postprandial glucose levels and better blood pressure control by which we have proved that GLP1 analogues in combination with basal insulin and metformin provide a good glycaemic control with a cardio protective effect, and reduce the risk of late complications.