Abstract
Abstract. Prediabetes remains a pressing medical and social issue, as it is considered one of the key factors increasing the risk of infertility in women of reproductive age. This metabolic condition causes dysfunction of the pancreatic insular apparatus due to the progression of insulin resistance (IR) and leptin resistance (LR), which increase the risk of developing type 2 diabetes (T2D). An important task for the medical community is to develop and scientifically substantiate patient-oriented treatment algorithms for prediabetes while preserving female fertility.
Aim. To evaluate the effectiveness of a 12-week course of treatment with sodium-glucose co-transporter 2 inhibitors (SGLT-2i: dapagliflozin (DAPA)) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs: liraglutide (LIRA)) in reproductive-age women with prediabetes.
Material and methods. The study involved 42 female patients aged 19 -45 years with prediabetes, who were divided into three groups according to the treatment algorithm: Group I (n=14) received basic drug therapy (BDT): metformin –500–2000 mg/day, alpha-lipoic acid – 600 mg/
day, cholecalciferol (vitamin D3) –800–10.000 IU/day, and inositol – 2,000 mg/day; Group II (n=14) used BDT in combination with SGLT-2i (DAPA – 10 mg/day); Group III (n=14) took BDT in combination with subcutaneous injections of GLP-1 RAs (LIRA at a daily dose of 0.6–3.0 mg). The study duration was 12 weeks.
Results. After 12 weeks of treatment, compared to baseline data, the best improvement in glucose metabolism was observed in patients who received LIRA injections as part of BDT. In Group III, glycosylated hemoglobin (HbA1c) decreased by 8.5% (β=−0.085, 95% CI [−0.112; −0.058], p<0.001), while in Group II, this parameter was 7.0% lower (β=−0.070, 95% CI [−0.097; −0.043], p<0.001). In contrast, in patients receiving BDT alone, a positive effect was observed with an HbA1c reduction of 3.67% (p<0.05). Women in Groups II and III demonstrated significant improvements in both insulin and leptin resistance indicators. The IR index decreased by 23.8% (β=−0.238, 95% CI [−0.360; −0.117], p<0.001) in Group II and by 28.4% (β=−0.284, 95% CI [−0.405; −0.162], p<0.001) in Group III. The LR index decreased by 18.3% (β=−0.183, 95% CI [−0.314; −0.051], p=0.007) and by 30.7% (β=−0.307, 95% CI [−0.439;−0.176], p<0.001), respectively.
Conclusions. The timely administration of DAPA (10 mg/day) or LIRA (0.6–3.0 mg/day) as part of BDT in reproductive-age women with prediabetes should be considered an effective personalized approach to treatment. This approach serves as a preventive measure against the progression of IR, LR, and the development of T2D.
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