Does comorbid obesity or chronic pancreatitis influence the choice and effectiveness of glucose-lowering therapy in type 2 diabetic patients?

Abstract

Introduction. The complexity of the interaction between type 2 diabetes mellitus (T2DM), comorbidities, and emerging complications requires a clinical approach that manages risk while maintaining indicated therapeutic goals. The objective of the study was to analyse the frequency and effectiveness of mono- A nd combined glucose-lowering therapy in T2DM patients with obesity and chronic pancreatitis (CP). Material and methods. The retrospective study analysed 579 medical records of T2DM patients, who were divided in the following groups: Group 1-patients with normal body weight and without CP (n=67); group 2-patients with normal body weight and with CP (n=32); group 3-overweight patients without CP (n=126); group 4-overweight patients with CP (n=33); group 5-obese patients without CP (n=262); group 6-obese patients with CP (n=59). When evaluating the effectiveness of the received therapy, the target value of HbA1c less than 7% was considered. Results. Most of the patients with T2DM+CP and T2DM with normal body weight received combined therapy. The presence of CP significantly influences the choice of treatment for T2DM, particularly, 81.5% of patients with T2DM and CP were prescribed combined therapy. There was no significant difference between serum glucose and HbA1c levels in patients with only T2DM and comorbid T2DM+CP+overweight/obesity regarding monotherapy vs combined glucose-lowering therapy. However, glucose and HbA1c levels in patients with only T2DM on monotherapy were significantly lower, respectively, by 41.72% and 25.64% vs patients with comorbid CP and overweight/obesity, who were also prescribed monotherapy. Conclusion. The presence of CP significantly influences the choice of treatment for T2DM, while overweight/obesity is not a criterion for choosing mono-or combined glucose-lowering therapy. The use of metformin as monotherapy and the use of combined therapy in most of patients with only T2DM and comorbid T2DM do not achieve the target levels of glucose and HbA1c.