Endocrine Abstracts

Rehabilitation of comorbid patients after acute myocardial infarction (AMI) with concomitant diabetes mellitus type 2 (DM2) and obesity requires application of personalized medical programs involving non–pharmacological physical methods and effective pharmacological therapy of DM2. The aim of the clinical case presentation is a description of the experience of complex medical rehabilitation of the middle–aged woman in the early period of AMI on the background of DM2 and morbid obesity using modern methods of physical therapy and liraglutide.

Case description: Female aged 51 years old was hospitalized in in–patient rehabilitation department with the diagnosis of Coronary heart disease; AIM of the left ventricle with growth of ST of 19.12.2019 (the 8th day); Stenting of the right coronary artery at 19.12.2019; DM2; Morbid obesity. The woman complained of dyspnea, increasing fasting blood glucose (FBG) up to 12 mmol/l.

Survey data: height 165 cm, weight 152 kg, BMI 55.8 kg/m², waist circumference (WC) 139 cm, hips circumference (HC) 143 cm, blood pressure (BP) 148/98 mm Blood panel and routine urine analyses were without any pathological changes. HbA1c 7.6%, serum FBG 9.1 mmol/l, total cholesterol (TC) 7.4 mmol/l, triglycerides (TH) 3.08 mmol/l, low density lipoproteins (LDL) 4.8 mmol/l, high density lipoproteins (LDL) 1.2 mmol/l.

Rehabilitation program: low–calorie diet, low–intensity laser exposure #10, cardiological complex of physical exercises in a gym #10, bike exercises in a gym #10, speleotherapy #10, low–intensity kinesiotherapy #10. Due to AIM metformin has been changed to liraglutide which was initiated in a dosage of 0.6 mg/day, followed by a dose increase of 0.6 mg/day per week up to a therapeutic dose of 1.8 mg/day. The patient was discharged in 12 days to continue her recovery in out–patient department. In 30 days: shortness of breath significantly decreased and tolerance to physical loads improved. Body weight 145 kg, BMI 53.3 kg/m², WC 132 cm, HW 140 cm, BP 124/79 mm Hg. Serum FBG 5.3 mmol/l, TH 6.9 mmol/l, TG 3.03 mmol/l, LDL 4.4 mmol/l, LDL 1.22 mmol/l. In 3 months: actively works, no complaints, weight 139 kg, BMI 51.1 kg/m², WC 128 cm, HC 132 cm, BP 125/78 mm Hg. Serum FBG 5.1 mmol/l, TH 5.9 mmol/l, TG 3.01 mmol/l, LDL 3.52 mmol/l, LDL 1.36 mmol/l, HbA1C 6.5%.

Conclusions: This clinical case demonstrates the results of complex rehabilitation of the middle–aged woman with AIM on the background of DM2 and morbid obesity using physical therapy methods and hypoglycemic pharmacological therapy with liraglutide.