Endocrine Abstracts

Background: Patient: male, 34 years old, height 32.4 cm (height 182 cm, weight 118 kg), heredity not severe, history of cholecystectomy, depressive background, takes Solian and Lemonex. Bad habits - smokes tobacco, does not drink alcohol. Covid 19 in 2021, vaccinated with 2 doses of Pfizer-BioNTech vaccine. 2023 In May, he was hospitalized with hyperglycemia, where insulin therapy was started: Apidra - 9 ⁰⁰ - 16IU 14⁰⁰ – 14IU 19⁰⁰ - 12 IU, Lantus 22 ⁰⁰ - 28 IU, but the glycemic profile ranged from 160 mg% to 270 mg%.

Method: He went to our clinic in September 2023. The main complaints were glycemic variability, weight gain, burning and pain in the extremities, and numbness. Based on the conducted examinations: HbA1c - 8.2% Vitamin D3 - 13.2 ng/ml (> 30ng/ml) Complete blood and urine count Cardioechoscopy with abdominal ultrasound: liver enlarged, thyroid v = 20 ml, echogenicity normal, no nodes present—astigmatism of the eye. Hepatitis is negative, and liver function and lipid metabolism are normal. Free testosterone 7.76 ng/dl (3.03-14.8 ng/dl), GSPG-18,94 mmol/l (17.30-65.80 mmol/l, Cortisol 10.95 μg/dl (4.3-22.4 μg/dl), Creatinine 77.18 μmol/l (62.0) -115.00 μmol/l), SCF-116 ml/min (75-128.00 ml/min), Anti-GAD-antibodies 0.61 U/ml (< 5.0 U/ml), Urea 31.12 mg/dl (15.00-38.50 mg/dl), C-peptide 0.32 nmol/l (0.2-0.8 nmol/l);

Results: Diagnosis: uncontrolled T2DM (A1C >8.2%), obesity (BMI 32.4 kg/m²), D3 vitamin deficiency. The treatment regimen/lifestyle was changed. Previously, the patient received no dietary recommendations; he was currently obese. The patient realized that excessive carbohydrate intake influenced his glucose control and agreed to improve his eating habits and walk 15–20 minutes twice daily. The treatment regimen changed and was prescribed: Ozempic 0.25 1 time a week (1 month), 0.5 1 time a week (1 month) at 1 mg\.. titration of the dose by months, simultaneously began to reduce the insulin dose with strict glucose control. In the evening, the patient was added metformin XR 1000 mg. Also, vitamin D3 used 5000 IU per day. A month later, the patient was completely canceled from insulin, he lost 8 kg. Motivation increased, and antidepressants decreased. After 3 months, weight decreased by 32 kg, HbA1c - 6.2%, glycemic profile adjusted, antidepressants discontinued, and the last dose of Ozempic - 1.5 mg. Treatment is ongoing.

Conclusion: Therefore, the proper management of a young patient with diabetes is of great importance; the use of GLP 1 inhibitors in relation to this patient not only reduced weight but also significantly changed his psycho-emotional state.