Issue: 2025, Vol. 30, No. 3

I. V. Muhin, V. R. Miminoshvili, Yu. S. Palamarchuk

EFFECT OF COMBINED GLUCOSE-LOWERING THERAPY ON DIASTOLIC PARAMETERS OF THE LEFT VENTRICLE IN TYPE 2 DIABETES MELLITUS

Keywords

combined glucose-lowering therapy, left ventricular diastolic parameters, type 2 diabetes mellitus

Abstarct

Objective – to analyse the effect of several regimens of combined glucose-lowering therapy (CGLT) on left ventricular diastolic function (LVDF) parameters in patients with type 2 diabetes mellitus (T2 DM). Material and Methods. The study involved 99 patients with type 2 diabetes mellitus and chronic heart failure (CHF) of NYHA functional class I–II with an ejection fraction ≥50%. Cardiosonography was performed by a standard method via transthoracic access at baseline 3 and 12 months later. The first group included 26 patients administered metformin and gliclazide as basic hypoglycaemic therapy. The second group of 25 patients received metformin and a glucagon-like peptide-1 (GLP-1) receptor agonist. Glucose-lowering therapy in 23 patients in the third group combined metformin and a dipeptidyl peptidase-4 (DPP-4) inhibitor. Twenty-five patients in the fourth group received a sodium-glucose cotransporter 2 (SGLT-2) inhibitor with metformin. Statistical data processing was performed using the Statistica 6.0 statistical software package. Results and Discussion. The analysis of the LV DF rate revealed impaired relaxation processes in the majority of the patients in every group that reflected the structural changes in the heart muscle with increased stiffness and reduced compliance and elasticity. The study being repeated in 3 months, showed no DF rate change; in our opinion, it is due to the relatively short interval between the initial and repeated studies. The frequency of the relaxation variant in patients in groups 1 and 2 increased significantly during the one-year follow-up, a tendency to decrease being in group 3, it decreasing significantly in group 4. There was nobody with pseudonormal and restrictive types of LV dysfunction of the diastolic type at the initial examination and 3 months later. However, the pseudonormal variant was observed in all groups with equal frequency after 12 months. The restrictive variant appeared after 3 months only in the representatives of groups 1 and 2. Conclusion. Relaxation is the predominant type of dysfunction in patients with type 2 diabetes mellitus and left ventricular dysfunction. Long-term CGLT with metformin and gliclazide and metformin with a GPP-1 receptor agonist showed an absolute increase in the frequency of the relaxation type and a tendency to form a restrictive type, which indicated the further progression of the processes of structural remodelling of the LV myocardium. Long-term use of metformin with a DPP-4 inhibitor inhibited the myocardial remodelling processes. CGLT with an NGLT-2 inhibitor and metformin contributed to a significant regression in the frequency of relaxation-type DF and its reclassification in 8% of patients to physiological (normal) LV diastolic function.

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