Abstract
Patients with type 2 diabetes mellitus differ widely in a number of important features of their disease - insulin secretion, insulin resistance, life prognosis, the presence of complications. The aim of this work is to attempt a simple definition of a patient who will benefit most from the treatment of substances from new groups of oral antidiabetics that can be chosen after metformin.
Gliptins should be the first choice in a patient with the onset of DM 2 type development diagnosed during a preventive examination. This is a patient with a newly diagnosed DM type 2, aged 50-70, who has glycated hemoglobin at about 50-60 mmol / l at the maximum tolerated dose of metformin and has no macrovascular complications.
The requirement is tight compensation of diabetes, as a basic prevention of complications specific to diabetes. Instead, pioglitazone is clearly the patient's therapy with clearly marked insulin resistance (elevated triacylglycerols).
Gliflozins administered to a patient at baseline with a relatively well-compensated metformin, without cardiovascular complications, are associated with a higher risk of subjectively perceived adverse events (reducing the adherence of patients to treatment) compared to gliptins and have a lower, at most comparable, effect on improving diabetes compensation. However, they are a good choice in those patients whose potential side effects are largely outweighed by the benefits of therapy, a population equivalent to that of the EMPA-REG OUTCOME study: long-term diabetes, insulin treatment, often in combination with sulfonylureas, and a history of cardiac or cerebral infarction.
The decisive factor for adherence to therapy in patients whose treatment does not relieve any subjective complaints is the absence of undesirable treatment effects.