Clinical efficacy of gliclazide with modified release after myocardial infarction in patients with concomitant type 2 diabetes

Abstract

Introduction. At present, the most clinically efficiency on reducing the risk of cardiovascular complications in patients with type 2 diabetes showed by intense step by step hypoglycemia strategy of therapy with sulfonylureas - gliclazide modified release. However, there is an insufficient number of works that would specifically study the effectiveness of this drug in patients with Q- myocardial infarction with concomitant type 2diabetes mellitus in the acute stage of the disease after 6 and 12 months of therapy.

Objective: to study the effectiveness of gliclazide modified release in patients with Q- myocardial infarction with concomitant type 2diabetes mellitus by its effect on the clinical course of the disease, glucometabolic control and humoral parameters during 12 months of observation.

Materials and Methods: we examined 99 patients with Q- myocardial infarction with metabolic syndrome and concomitant type 2diabetes mellitus, 52 men (52.53%) and 47 women (47.47%), average age (62,9 ± 2, 05) years. The main group consisted of 28 patients who in addition to basic therapy were prescribed gliclazide modified release in a dose of 30-60 mg;71 patients were in the comparison group, treated with glibenclamide. Immunoenzyme method was carried out to determine the level of IL-1α, IL-6, TNF-α (Diaclone, France), endothelin-1 (Biomedica, Austria), insulin-like growth factor, insulin, C-peptide, leptin, C-reactive protein (DAI, USA), tissue plasminogen activator inhibitor-1 (Biopool, USA).The concentration of glucose, glycosylated hemoglobin investigated using a set of reagents BIOLATEST company PLIVA-Lachema. The data are processed by methods of variation statistics using application package «Statistica 6.0» by standard requirements.

Results: Gliclazide modified release inclusion in the basic treatment of patients with type 2 diabetes after myocardial infarction associated with reduced mortality - in 2.29-fold (p <0.05), frequency of development of non-fatal myocardial infarction at 14.74% (p <0.05), likely decrease in blood glucose, glycosylated hemoglobin, insulin and leptin during 12 months of therapy. Side effects in applying gliclazide was not observed. In patients treated with gliclazide modified release after 6 months of treatment compared with glibenclamide group was significantly lower concentration of interleukin-6 in 42.51% (p <0.05), tumor necrosis factor-α to 18.54% (p <0.05), endothelin-1 to 52.80% (p <0.01), tissue plasminogen activator inhibitor-1 to 67.12% (p <0.05);after 12 months - interleukin-6 at 58.02% (p <0.01), tumor necrosis factor-α to 17.54% (p <0.05), endothelin-1 to 63.98% (p <0 , 01), tissue plasminogen activator inhibitor-1 to 80.74% (p <0.05), indicating that the benefits of the drug by the effects on endothelial dysfunction and inflammatory changes.

Conclusions: gliclazide modified release long-term use in patients with myocardial infarction with type 2 diabetes mellitus has a positive effect on the clinical course of the disease, which is manifested in a decrease in frequency of development non-fatal myocardial infarction and mortality 2.29 times during the 12 months of observation, provides effective glucometabolic control and optimum portability.In patients with myocardial infarction with type 2 diabetes mellitus gliclazide modified release reduces the severity of hyperinsulinemia, hiperleptynemiyi and signs of endothelial dysfunction, prevents thrombus formation, reduces the concentration of proinflammatory cytokines during 12 months of therapy.