SCIENCE & INNOVATION

TREATMENT OF TYPE 2 DM WITH NEW CLASS DRUGS: I DPP-4, A GLP-1, AND SGLT-2

29.01.2023 International Scientific Journal "Science and Innovation". Series D. Volume 2 Issue 1

Kasimova Tahmina, Ismailov S.I., Nasirova H.K., Narimova G.Zh.

Abstract. The annual increase in patients with type 2 diabetes averages 12.3%. The largest number of patients with type 2 diabetes is patiants aged 51 to 58 years - 10.2% of men and 16.2% of women. Treatment of type 2 diabetes is aimed at minimizing the risk of developing micro- and macrovascular complications. The emergence of new antidiabetic drugs, the action of which is based on the enhancement of the effect of endogenous incretins, opens up new prospects in the treatment of type 2 diabetes. Despite the fact that 2 classes of these drugs (DPP-4 inhibitors and GLP analogs) belong to chemically different and structurally independent compounds, they have a similar mechanism of action, which consists in regulating glucose homeostasis by affecting the processes of glucose-dependent synthesis of insulin and glucagon, influencing consumption food and the promotion of chyme, on the proliferation, differentiation of pancreatic B-cells. A significant advantage of DPP-4 inhibitors is the possibility of their use in tablet form, unlike injectable GLP analogues. It is also important that DPP-4 inhibitors do not cause significant side effects, do not increase the incidence of hypoglycemia, and do not lead to weight gain. It has been shown that long-term subcutaneous administration of GLP-1 to patients with type 2 diabetes (for 6 weeks) improved the function of b-cells, reduced the level of glucose and glycosylated hemoglobin (HbA1c), and increased peripheral insulin sensitivity; in addition, a decrease in body weight of patients has been recorded. However, as already noted, the period of circulation of endogenous or exogenous GLP-1 in the blood is extremely short due to the rapid inactivation of incretins under the action of the dipeptidyl peptidase-4 enzyme. To ensure the practical use of native GLP-1 as a new agent in the treatment of type 2 DM, it is advisable to prevent the rapid breakdown of GLP-1 using DPP-4 inhibitors. Sodium-glucose cotransporter type 2 (SGLT2) inhibitors are a new class of oral antidiabetic drugs that reduce glycemia independently of insulin and beta-cell function. SGLT2 inhibitors, due to the unique mechanism of action that does not depend on the severity of insulin resistance and beta-cell deficiency, are equally effective both in patients with type 2 diabetes with a disease duration of less than one year and in patients with type 2 diabetes of a long course (more than ten years). All inhibitors are highly selective for SGLT2 over SGLT1. The safety of these drugs is due to an extremely narrow spectrum of action - inhibition of a specific protein, which is present almost exclusively in the epithelial cells of the proximal tubules of the nephron.

Keywords: type 2 diabetes, incretins, mechanisms of action, new combinations of hypoglycemic drugs, glucagon-like peptide, SGLT.