Endocrine Abstracts

Introduction

Metformin and vildagliptin are the medications amongst first-line treatment options in type 2 diabetes patients. Few recent studies have explained positive pleotropic effects of metformin therapy by telomerase activation and telomeres length in leukocytes preservation. Knowing the primary role of insulin-signalling pathway in insulin resistance development and physiology of ageing, it is possible to suggest, that one of the protective mechanisms of metformin and vildagliptin therapy is their ability to increase telomerase activity and thus to prevent accelerated telomeres shortening.

Aim of the study

To investigate effects of combined therapy with vildagliptin and metformin and their influence on telomerase activity in patients with type 2 diabetes.

Materials and methods

Total of 50 patients with diabetes were included in the study. Mean age was 58.4 ± 7.90 years. Diabetes duration was 0.9 ± 0.09 years. The patients were randomized with 1:1 ratio to a group treated with metformin 2000 mg/day and a group, which was given vildagliptin + metformin 100/2000 mg/day combination therapy. There were no statistically significant differences in age, sex, blood pressure, main carbohydrate metabolism parameters and vessel wall state between two groups. All patients were given recommendations on lifestyle changes (diet and physical activity). In 12 months after the initiation of treatment we performed: pulse wave velocity measurement, carotid arteries duplex scan, telomerase activity investigation on monocyte fraction of blood cells and pre-prandial glucose and HbA1c measurements. Statistical analysis was performed using SPSS 23.0.

Results

Examination after 12 months of treatment demonstrated, that either metformin monotherapy or its combination with vildagliptin had led to a significant glycaemic control improvement. In group 1 (metformin only) HbA1c and glucose levels decrease was 8.28% and 3.2% respectively, and in group 2 (combination therapy) – 3.4% and 1.5% respectively, reaching the normal range. The number of patients, who reached HbA1c less than 7.5% goal was 87.6% in group 1 and 64.7% in group 2. In group 2 were revealed statisitically significant increase in telomerase activity from 0.87 to 1.15 (P < 0.01) in contrast with group 1, where we observed a significant decrease in telomerase activity from 0.89 to 0.64 (р=0.01). After comparing all the numbers between two groups, we found, that vildagliptin + metformin combination therapy had a positive effect on changes in pulse wave velocity (P < 0.001), body mass(P < 0.001) and telomerase activity (P < 0.001).

Conclusion

Based on the obtained results it is possible to suggest the finding of a new independent pleotropic effect of metformin + vildagliptin combination therapy – the modulation of telomerase activity.