Effect of various pharmacotherapy regimens on the state of carbohydrate metabolism in patients with urination disorders

Aim. To evaluate the efficacy and safety of various pharmacotherapy regimens in patients with urination disorders and type 2 diabetes mellitus during their preparation for surgery.

Materials and methods. In total, 130 people (56 men and 74 women) aged from 18 to 81 years (average 65 years) were included in the research. All the patients were on standardized hypoglycemic therapy in combination with alpha1-blockers (doxazosin, terazosin) and vitamin-like drugs (alpha-lipoic acid, levocarnitine). Patients were divided into male and female subgroups, as well as into age subgroups, including under 65 years and over 65 years. Tabular methods of assessing the clinical symptoms of urinary disorders were used, along with instrumental, laboratory, and statistical methods (Mann-Whitney test, Spearman rank correlation coefficient).

Results. The duration of therapy averaged 16± 2 months. The observation found that alpha1-blockers lead to a number of positive changes in the composition of carbohydrate metabolism, i.e., the level of serum glucose and insulin. In the general observation group, a significant decrease in blood glucose from 6.64 to 6.27 mmol/L, insulin from 18.07 to 14.03 mU/mL, and C-peptide from 3.67 to 2.98 ng/mL was detected. In the male subgroup, glucose levels decreased from 6.45 to 6.00 mmol/L, insulin from 18.92 to 13.99 mU/mL, and C-peptide from 3.76 to 2.97 ng/mL. In the female subgroup, blood glucose levels decreased from 6.98 to 6.77 mmol/L, insulin from 16.41 to 14.1 mU/mL, and C-peptide from 3.51 to 2.99 ng/mL. In the group of patients younger than 65 years of age, a decrease in glucose from 6.22 to 5.93 mmol/L, insulin from 17.87 to 14.36 mU/mL, and C-peptide from 3.49 to 3.01 ng/mL were also observed. In the group of patients older than 65 years of age, similar dynamics of the above parameters was established.

Conclusions. The data obtained suggest that alpha1-blockers in combination with vitamin-like drugs contribute to reducing the level of serum glucose, insulin, and C-peptide during a long-term (at least 1 year) therapy, which may be promising in the correction of metabolic disorders during preparation of patients for surgery.

1. Kuzmin IV, Shabudina NO, Al-Shukri AS. Symptoms and clinical course of cystopathy in patients with type 2 diabetes mellitus. Diabetes mellitus. 2013;16(2):73–6 (In Russ.) doi: 10.14341/2072-0351-3759

2. Dedov II., Shestakova MV, Vikulova OK, Zheleznyakova AV, Isakov MA, Sazonova DV, Mokrysheva NG. Diabetes mellitus in the Russian Federation: dynamics of epidemiological indicators according to the Federal Register of Diabetes Mellitus for the period 2010–2022. Diabetes mellitus. 2023;26(2):104-23 (In Russ.)

3. Efimov EV, Shapkin YuG. Metabolic disorders in the basis of regeneration disorders in diabetes mellitus. Zemskoj vrach. 2014;23(2):26–8 (In Russ).

4. Danilov VV, Nidzelsky PD. Modern urology and the implementation of its new directions in a multidisciplinary hospital. Pacific Medical Journal. 2011;1:5–8 (In Russ).

5. Sukhorukov VS, Narcissov RP, Petrichuk SV. Comparative diagnostic value of skeletal muscle and lymphocyte analysis in mitochondrial diseases. Arkhiv Patologii. 2000;62(2):19–21 (In Russ.)

6. Pollare T., Lithell H., Selinus I., Berne C. Application of prazosin is associated with an increase of insulin sensitivity in obese patients with hypertension. Diabetologia. 1988;31(7):415–20. doi: 10.1007/BF00271585

7. Lehtonen A. Doxazosin effects on insulin and glucose in hypertensive patients. AHJ. 1991;121(4):1307–11. doi: 10.1016/0002-8703(91)90438-N

8. Giorda C., Appendino M. Effects of Doxazosin, a Selective a1-Inhibitor, on Plasma Insulin and Blood Glucose Response to a Glucose Tolerance Test in Essential Hypertension. Metabolism. 1993;42(11):1440–2. doi: 10.1016/0026-0495(93)90196-U

9. Ueshiba H., Miyachi Y. Effect of Doxazosin on Insulin Resistance in Hypertensive Patients with Obesity. Horm Metab Res. 2003;35(9):532–6. doi: 10.1055/s-2003-42654

10. Tory M. Hagen,Jiankang Liu, Jens Lykkesfeldt, Carol M. Wehr, Russell T. Ingersoll, Vladimir Vinarsky,James C. Bartholomew, and Bruce N. Ames. Feeding acetyl-l-carnitine and lipoic acid to old rats significantly improves metabolic function while decreasing oxidative stress. PNAS.2002;99(4):1870–5. doi: 10.1073/pnas.261708898

11. Tkachuk VA, Vorotnikov AV. Molecular Mechanisms of Insulin Resistance Development. Diabetes mellitus. 2014;(2):29–40. (In Russ.)]. doi: 10.14341/DM2014229-40