Optimized treatment of elderly patients with type 2 diabetes mellitus and hypertension in general practice

Abstract

Background. Population aging has become a leading demographic feature of Ukraine. According to the World Health Organization, the number of elderly and senile people will increase to almost 40 % in the coming decades. Hypertension and type 2 diabetes mellitus (DM) are among the leading factors of cardiovascular risk. It is known that excessive oxidant stress and low-grade subclinical chronic systemic inflammation are determining factors of endothelial dysfunction, vascular reactivity disorders, increased peripheral vascular resistance, carbohydrate, and lipid metabolism disorders, which leads to increased blood pressure and plasma glucose levels. Hypertension and type 2 DM are among the leading cardiovascular risk factors. The purpose of the study was to increase the effectiveness of treatment and improve the quality of life of elderly patients with combined pathology of hypertension and type 2 DM by additional inclusion of empagliflozin and L-arginine in the basic therapy. Materials and methods. Fifty elderly patients with comorbid pathology were under our observation for second stage hypertension, coronary heart disease (functional class II) and type 2 DM in the stage of subcompensation. Participants were divided into two groups: the first one, controls (n = 25), received generally accepted basic therapy. In the second group (n = 25), the following drugs were added to the basic therapy: empagliflozin 10 mg/day, L-arginine 300 mg/day. Results. Clinical observation in outpatient conditions lasted for 3 months. Comprehensive therapy in the elderly patients with comorbid pathology of hypertension and type 2 diabetes, with the additional inclusion of empagliflozin and L-arginine to the basic therapy, contributes to a significant positive effect on the clinical course, reduces the risk of progression of this constellation. Conclusions. The application of the proposed comprehensive therapy in outpatient conditions under the control of a family doctor will significantly improve the quality of life of patients and prevent the development of complications

Full text

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87
Vol. 20, No. 2, 2024
Оригінальні дослідження
Original Researches
UDC 616.12-008.331.1:616.379-008.64-085 DOI: https://doi.org/10.22141/2224-0721.20.2.2024.1368
Yu.M. Kazakov , O.V. Muravlova , T.V. Nastroga , O.E. Kitura , S.V. Shut
Poltava State Medical University, Poltava, Ukraine
Optimized treatment of elderly patients
with type 2 diabetes mellitus
and hypertension in general practice
For citation: Mìžnarodnij endokrinologìčnij žurnal. 2024;20(2):87-92. doi: 10.22141/2224-0721.20.2.2024.1368
Abstract. Background. Population aging has become a leading demographic feature of Ukraine. According to
the World Health Organization, the number of elderly and senile people will increase to almost 40 % in the coming
decades. Hypertension and type 2 diabetes mellitus (DM) are among the leading factors of cardiovascular risk. It is
known that excessive oxidant stress and low-grade subclinical chronic systemic inflammation are determining factors
of endothelial dysfunction, vascular reactivity disorders, increased peripheral vascular resistance, carbohydrate,
and lipid metabolism disorders, which leads to increased blood pressure and plasma glucose levels. Hypertension
and type 2 DM are among the leading cardiovascular risk factors. The purpose of the study was to increase the
effectiveness of treatment and improve the quality of life of elderly patients with combined pathology of hypertension
and type 2 DM by additional inclusion of empagliflozin and L-arginine in the basic therapy. Materials and methods.
Fifty elderly patients with comorbid pathology were under our observation for second stage hypertension, coro-
nary heart disease (functional class II) and type 2 DM in the stage of subcompensation. Participants were divided
into two groups: the first one, controls (n = 25), received generally accepted basic therapy. In the second group
(n = 25), the following drugs were added to the basic therapy: empagliflozin 10 mg/day, L-arginine 300 mg/day.
Results. Clinical observation in outpatient conditions lasted for 3 months. Comprehensive therapy in the elderly
patients with comorbid pathology of hypertension and type 2 diabetes, with the additional inclusion of empagliflozin
and L-arginine to the basic therapy, contributes to a significant positive effect on the clinical course, reduces the
risk of progression of this constellation. Conclusions. The application of the proposed comprehensive therapy in
outpatient conditions under the control of a family doctor will significantly improve the quality of life of patients and
prevent the development of complications.
Keywords: hypertension; type 2 diabetes mellitus; elderly patients; empagliflozin; L-arginine
Introduction
Population aging has become a leading demographic fea-
ture of Ukraine. According to the World Health Organiza-
tion, the number of elderly and senile people will increase to
almost 40 % in the coming decades [1, 2]. Hypertension and
diabetes mellitus (DM) type 2 are among the leading factors
of cardiovascular risk [3]. It is known that excessive oxidant
stress and low-grade subclinical chronic systemic inflam
-
mation are determining factors of endothelial dysfunction,
vascular reactivity disorders, increased peripheral vascular
resistance, carbohydrate and lipid metabolism disorders,
which leads to increased blood pressure (BP) and plasma
glucose levels [4]. With the growing burden of metabolic
disease, cardiovascular disease, and diabetes mellitus, there
is an implication for new pharmacological intervention. So-
dium-glucose cotranspor ter 2 (SGLT2) inhibitors are a class
of drugs that work on SGLT2 receptors in the kidneys to de-
crease glucose reabsorption. Lowering glucose levels mainly
aids those with type 2 DM, but they also have many other
effects on the body [5].
L-arginine, an endogenous amino acid, is a safe sub-
stance that can be found in food. The compound is involved
in synthesis of various products responsible for regulatory
functions in the body. Among others, nitric oxide, a signa-
ling molecule regulating carbohydrate and lipid metabolism,
is particularly noteworthy. The increasing experimental and
©2024.The Authors.This is an open access article under the terms of theCreative Commons Attribution 4.0 International License,CC BY,which allows others to freely distribute the
published article, with the obligatory reference to the authors of original works and original publication in this journal.
Для кореспонденції: Муравльова Оксана Василівна, кандидат медичних наук, доцент, завідувач кафедри ендокринології з дитячими інфекційними хворобами, Полтавський державний
медичний університет, вул. Шевченка, 23, м. Полтава, 36011, Україна; е-mail: endocrinology@pdmu.edu.ua, o.muravlova@pdmu.edu.ua, mur_ov_pdmu@ukr.net; тел.: +380(50)7619084
For correspondence: Oksana Muravlova, PhD, Associate Professor, Head of the Department of Endocrinology with Pediatric Infectious Diseases, Poltava State Medical University, Shevchenko Street, 23,
Poltava, 36011, Ukraine; е-mail: endocrinology@pdmu.edu.ua, o.muravlova@pdmu.edu.ua, mur_ov_pdmu@ukr.net; phone: +380(50)7619084
Full list of authors’ information is available at the end of the article.

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Vol. 20, No. 2, 2024Mìžnarodnij endokrinologìčnij žurnal,
ISSN 2224-0721 (print), ISSN 2307-1427 (online)
Оригінальні дослідження / Original Researches
clinical data indicate that L-arginine supplementation may
be helpful in managing metaboliс disorders in obesity, regu-
lating blood pressure or alleviating type 2 DM symptoms,
but the mechanisms underlying these effects have not been
sufficiently elucidated [6]. Any improvement in endothelial
function contributes to the prevention of cardiovascular
di seases. As a functional amino acid, L-arginine serves not
only as a building block of protein but also as an essential
substrate for the synthesis of nitric oxide (NO), creatine,
polyamines, homoarginine. NO (a major vasodilator) in-
creases blood flow to tissues and contributes to a moderate
reduction of systolic (SBP) and diastolic blood pressure
(DBP) [7, 8].
Psychosocial stress has been long known to have dele-
terious effects on health and is considered a modifiable risk
factor for stroke. Given the prevalence of chronic and acute
exposure to stress, it represents a potentially attractive target
for population-health interventions [9]. It is also known that
with age, there is an increase in sensitivity to humoral influ-
ences (in particular, adrenaline), which leads to increased
sensitivity of the myocardium of older people to stressors
[10]. Also, improvements in the circadian rhythm of blood
pressure under the influence of treatment that improve the
quality of sleep have been noted [11].
The aim of the study was to increase the effectiveness of
treatment and to improve the quality of life of elderly patients
with combined pathology of hypertension and type 2 DM
with the help of additional therapy with empagliflozin and
L-arginine.
Materials and methods
We monitored 50 elderly patients with comorbid patho-
logy of second-stage hypertension, coronary heart disease:
functional class II angina pectoris and type 2 DM in the
subcompensation stage. Duration of disease was more than
10 years. Patients gave informed consent in compliance
with the principles of bioethics and deontology during the
study in accordance with the principles of the Declaration
of Helsinki.
The average age of the patients was 66.8 ± 2.3 years.
Clinical diagnoses were determined in accordance with the
Order of the Ministry of Health of Ukraine dated May 24,
2012 No. 384 and the current Unified Clinical Protocols
“Hypertension” of 2016, Order of the Ministry of Health of
Ukraine dated December 23, 2021 No. 2857 “Stable Ische-
mic Heart Disease” and Order of the Ministry of Health of
Ukraine of December 21, 2012 No. 1118 “Unified Clinical
Protocol of Primary and Secondary (Specialized) Medical
Care for Type 2 Diabetes”, as well as new 2023 Euro pean
Society of Cardiology guidelines [12]. Patients were exami-
ned using general clinical, laboratory and instrumental
methods.
BP measurement in the elderly patients with hyperten-
sion and diabetes was carried out after 5 minutes at rest on
both arms. To rule out possible orthostatic hypertension, BP
was measured after 1 and 3 minutes in a standing position.
Thickening of the common and internal carotid artery walls,
or the presence of atherosclerotic plaques, as well as inti-
ma-media thickness (IMT) were determined using duplex
scanning on an ultrasound scanner ACCUVIX A30 (Sam-
sung Medison, South Korea) with a linear sensor in B-mode
in three places on distance of 1.5 cm from the bifurcation of
the distal part of the right and left common carotid artery,
internal carotid artery along the anterior wall.
The diagnostic criterion for increased IMT was conside-
red to be ≥ 0.9 mm, the presence of an atherosclerotic plaque
was noted with local thickening of IMT ≥ 1.5 mm or thicke-
ning of more than 50 % of the lumen of the vessel, or 0.5 mm
according to other areas of IMT. Endothelium- dependent
vasodilation (EDV) was calculated using the formula:
EDV = (d60 – d0) × 100 % / d0, where d60 is the diameter
of the brachial artery (BA) 60 seconds after the restoration
of blood circulation, d0 is the initial diameter of the brachial
artery. Endothelium-dependent vasodilation is calculated
by the difference in the diameter of the artery. Endothelial
dysfunction was considered to be at < 10 % EDV BA [13].
Parameters of plasma hemostasis were determined: levels
of fibrinogen, activated partial thromboplastin time (aPTT).
Blood lipids were studied: the levels of total cholesterol (TC),
triglycerides (TG), high-density lipoprotein cholesterol
(HDL-C), and low-density lipoprotein (LDL-C) choles-
terol. Careful monitoring of the following indicators was car-
ried out: glycated hemoglobin (HbA1c), BP and body mass
index (BMI). The psychological state of the patients was
determined using Spielberger-Khanin questionnaire. The
results were evaluated in points: less than 30 points — low
anxiety; 31–45 — moderate anxiety; 46 or more points —
high anxiety [14].
Statistical processing of the results was carried out using
Prism5 (version 5/03) Microsoft Excel 2010 software packa-
ges, methods of descriptive statistics and statistical analy-
sis. The probability of the obtained results was determined
using the Student’s t-test of reliability. Differences were
considered insignificant at the probability of error Р < 0.05
generally accepted in medical and biological research.
Correlation between quantitative indicators was assessed
using the Pearson correlation coefficient (r). All patients
were given personalized motivational recommendations
for lifestyle changes: a rational diet with a restriction of salt
(up to 5 g per day) and simple carbohydrates, a decrease
in the consumption of saturated fats and trans fats, and
an increase in polyunsaturated fatty acids and dosed fiber;
dosed physical activity: slow walking for 40 minutes 4 times
a week; careful control of glycemia, monitoring of BP and
body weight at home.
The patients were divided into two groups. The first one
(controls, n = 25) received the generally accepted basic
thera py: angiotensin-converting enzyme inhibitor — pe-
rindopril, calcium antagonist — amlodipine, antiplatelet
agent — acetylsalicylic acid, statin — rosuvastatin, glu-
cose-lowering therapy — metformin. The second (main)
group (n = 25) had the following drugs added to the ba
-
sic therapy: SGLT2 inhibitor empagliflozin 10 mg/day and
L-arginine 300 mg/day. Clinical observation in outpatient
conditions lasted for 3 months.
Results
Before the beginning of treatment, all elderly patients
with comorbid pathology of hypertension and type 2 DM
had complaints of headache, dizziness was noted in 43

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(86 %) cases, sleep disorders in 48 (96 %), periodic pain
in the lo wer limbs when walking in 46 (92 %), periodic
seizures in 26 (52 %), weakness in the legs in 36 (72 %),
nervous tension, or irritability and restlessness were noted
by all patients (100 %). The listed complaints testified to
characteristic clinically significant symptoms of macro-
angiopathy and psychopathological disorders, which sig-
nificantly worsen the prognosis and the process of social
adaptation of the elderly.
The average duration of reduction of the main clinical
symptoms (headache) in the main group was 4.30 ± 0.33
days, while in the comparison group 5.90 ± 0.41 days
(P < 0.05); normalization of sleep — 5.10 ± 0.44 days, and
6.40 ± 0.38 days in the controls (P < 0.05). The obtained
results show that in patients of the main group, the nor-
malization of sleep, reduction of clinical symptoms such as
headache occurred in a shorter time.
The average level of reactive anxiety (RА) in patients
of the main group before treatment was 47.8 ± 2.2 points,
which indicates its high level. Clinically, this was manifes-
ted by a feeling of mildly and moderately expressed anxie-
ty, worry, sleep disturbances. After treatment, the anxiety
was 40.10 ± 2.94 points, decreased by 16.1 % (P < 0.05).
The average level of personal anxiety (PА) before treat-
ment in the comparison group was 47.20 ± 3.12 points, af-
ter treatment, it decreased not significantly, by 9.1 %, and
was 42.9 ± 2.5 points (Р > 0.05). There were no significant
differences in the level of PA after the course of therapy.
The obtained results allow us to state that comprehensive
therapy significantly reduces the level of RА, contributes to
the normalization of sleep and improves the quality of life
of patients.
The comparative evaluation of the integral standard
indicator of carbohydrate metabolism in patients of the
main group demonstrated a significant decrease in the ave-
rage level of HbA1c by 14.1 % (before treatment, it was
7.70 ± 0.33 %, after treatment — 6.52 ± 0.41 %) (p < 0.05),
while in the controls, HbA1c decreased not significantly, by
9 %, from 7.45 ± 0.65 % to 6.78 ± 0.51 (Р > 0.05). It can be
assumed that the hypoglycemic effect of empagliflozin and
L-arginine is due to a positive impact on the regulation of
insulin synthesis and release, an increase in its content in
the blood, a decrease in insulin resistance and an increase
in the sensitivity of tissues to insulin, an increase in the
utilization of glucose, which coincides with the opinion of
scientists [15, 16].
After the treatment, SBP and DBP decreased sig-
nificantly in patients of the main group. SBP reduced in
them by 25.5 % (from 175.2 ± 4.1 mmHg before treat-
ment to 131.40 ± 3.63 mmHg after it) (p < 0.05), while
in the controls — by 19.1 % (from 172.80 ± 4.52 mmHg
to 137.4 ± 3.5 mmHg) (P < 0.05). DBP in the research
group decreased by 25.2 % (from 96.4 ± 4.2 mmHg
to 73.2 ± 6.1 mmHg) (p < 0.05), in the control group,
a non-significant decrease in diastolic blood pressure by
16.4 % was noted (from 94.7 ± 5.9 to 79.2 ± 6.8) (Р > 0.05).
The obtained results convincingly prove the positive thera-
peutic effect of comprehensive therapy with the use of em-
pagliflozin and L-arginine, which contributes to increasing
the effectiveness of antihypertensive drugs.
After the course of therapy, an improvement in the
blood lipids was noted. A more significant positive trend
was observed in the level of TG (p < 0.05): in the main
group, it decreased by 25.7 % (from 1.91 ± 0.12 mmol/l to
1.42 ± 0.18 mmol/l) (p < 0.05), while in the controls by
17.1 % (from 1.88 ± 0.20 mmol/l to 1.56 ± 0.13 mmol/l)
(p > 0.05). Under the influence of comprehensive therapy,
there was a significant decrease in the level of fibrinogen by
12.1 % (before treatment, it was 4.53 ± 0.16, after treat-
ment 4.01 ± 0.21 g/l (р < 0.05) in the main group, while
in the comparison group, it reduced only by 7.2 % (from
4.41 ± 0.34 to 4.14 ± 0.29 mmol/l) (p > 0.05).
After the course of therapy, the patients of the main group
reported an increase in the level of aPTT to 23.70 ± 0.55
seconds, while in the controls, this indicator did not in-
crease significantly and was 21.8 ± 0.8 seconds (p < 0.05).
An increase in the level of fibrinogen and a decrease in aPTT
indicates the activation of coagulation hemostasis in the el-
derly with comorbid pathology of hypertension and type 2
DM. After a course of comprehensive therapy, a decrease in
Table 1. The results of laboratory-instrumental studies in the elderly patients with comorbid pathology
of hypertension and type 2 DM
Indicators Main group (n = 25) Comparison group (n = 25)
Before treatment After treatment Before treatment After treatment
TC, mmol/l 5.57 ± 0.64 4.13 ± 0.51 5.42 ± 0.59 4.60 ± 0.72
LDL-C, mmol/l 0.95 ± 0.13 1.12 ± 0.22 0.99 ± 0.28 1.08 ± 0.21
HDL-C, mmol/l 3.82 ± 0.23 2.90 ± 0.26 3.91 ± 0.32 3.24 ± 0.29
TG, mmol/l 1.91 ± 0.12* 1.42 ± 0.18 1.88 ± 0.20 1.56 ± 0.13
Fibrinogen, g/l 4.53 ± 0.16* 4.01 ± 0.21 4.41 ± 0.34 4.14 ± 0.26
aPTT, sec 21.3 ± 0.8 23.70 ± 0.55** 20.10 ± 0.76 21.80 ± 0.80
AI 4.89 ± 0.54* 2.98 ± 0.31 4.47 ± 0.42 3.25 ± 0.23*
IMT CA 1.28 ± 0.06* 1.04 ± 0.08 1.22 ± 0.09 1.130 ± 0.076
EDV BA 6.48 ± 0.31 7.85 ± 0.44* 6.31 ± 0.33 7.02 ± 0.51
Notes: * — differences before and after treatment are reliable; ** — differences are reliable between patients of
the main and control groups after treatment.

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ISSN 2224-0721 (print), ISSN 2307-1427 (online)
Оригінальні дослідження / Original Researches
the content of fibrinogen, an increase in aPTT was noted in
patients of the main group, which indicates a decrease in co-
agulation properties and an improvement in blood rheo logy
that coincides with the results of researchers [17].
Evaluation of the results of a carotid artery duplex scan
confirmed the thickening of the intima-media of the com-
mon carotid artery. After the course of therapy, the carotid
artery IMT in the main group decreased by 18.7 % (from
1.28 ± 0.06 to 1.04 ± 0.08 (p < 0.05), while in the com-
parison group, the reduction of 7.4 % (from 1.22 ± 0.09 to
1.130 ± 0.076) was insignificant (p > 0.05).
In the patients of the main group, a significant in-
crease in the absolute index of the artery diameter was no-
ted. The EDV in patients of the main group increased by
17.9 %, from 6.48 ± 0.31 to 7.85 ± 0.44 (p < 0.05), while
in the controls, an insignificant increase was noted — by
11.4 % (from 6.31 ± 0.33 to 7.02 ± 0.51) (p > 0.05). Thus,
the use of L-arginine in the comprehensive treatment of
elderly patients with hypertension and type 2 DM con-
tributes to the improvement of endothelium-dependent
vasodilation.
BMI showed a significant decrease in the main group af-
ter the course of therapy, by 5.7 % (from 29.9 ± 0.7 kg/m2 to
28.1 ± 0.4 kg/m
2
) (p < 0.05), while in the controls, an insig-
nificant decrease by 1.4 % was noted (from 30.1 ± 0.9 kg/m
2
to 29.7 % ± 0.6 kg/m2). It can be assumed that comprehen-
sive therapy with the use of empagliflozin contributes to the
reduction of insulin resistance and the activation of catabolic
processes such as increased lipolysis and fat oxidation, which
contributes to weight loss.
After the course of therapy, 13 (52 %) patients of the
main group and 5 (21 %) patients of the control group noted
a reduction in the symptoms of macroangiopathy of the lower
extremities (p < 0.05), which suggested a positive effect and
the effectiveness of the proposed comprehensive therapy in
the elderly.
Discussion
The pandemic of type 2 DM has become a serious pub-
lic health threat [18]. A consistent downward trend in the
age of type 2 DM onset even worsens the situation [19].
Mounting evidence has demonstrated that the younger the
age at diabetes onset, the greater the risk of diabetes-related
comorbidities, e.g., cardiovascular diseases and prema-
ture mortality [20]. The existence of “metabolic memory”,
when the influen ce of an early glycemic exposure environ-
ment is imprinted in target cells and organs and leads to
prolonged impairments even after optimal glucose control
[21], emphasizes the need for the clinical priority of early
identification and intervention against risk factors for type
2 DM [22].
Our study found a significant interaction between cumu-
lative inflammation and atherogenic dyslipidemia associated
with type 2 DM onset among the general population.
Endothelial dysfunction contributes to the development
and progression of atherosclerosis, which leads to cardio-
vascular complications [23]. Among the most significant
mechanisms of endothelial dysfunction, there is a disruption
of the metabolism of L-arginine — NO, which is the main
effector molecule produced by endotheliocytes [24]. The
results of the study indicate that the use of L-arginine in
the comprehensive treatment of elderly patients with hy-
pertension and diabetes can be successfully combined with
standard hypotensive therapy and can contribute to the ad-
ditional reduction of systolic and diastolic blood pressure; it
also prevents the progression of the atherosclerotic process.
Additional use of empagliflozin in the comprehensive the-
rapy contributes to the blood glucose reduction through an
insulin-independent mode of action, namely, increasing the
excretion of glucose in the urine [5]. In addition, empagli-
flozin enhances the fractional excretion of sodium and has
a moderate diuretic and natriuretic effect, which also helps
reduce blood pressure and uric acid levels and is appropriate
in the comprehensive treatment of patients prone to hyper-
tension and type 2 DM [5].
Elderly patients with hypertension and type 2 DM have
a high level of RA, poor sleep, which justifies the need to use
comprehensive therapy. A reliable positive correlation found
between the level of RA and blood pressure before treatment
in the main (r = 0.448; p < 0.005) and comparison groups
(r = 0.385; p < 0.005), between the level of HbA1c and to-
tal cholesterol before treatment in both groups (r = 0.158;
p < 0.005 and r = 0.472; p < 0.005, respectively) proves that
a controlled decrease in the level of HbA1c prevents the pro-
gression of atherosclerosis, long-term micro- and macrovas-
cular events.
The use of the proposed comprehensive therapy in the
elderly with hypertension and type 2 DM in the outpatient
settings under the supervision of a family doctor will signifi-
cantly improve the quality of life of patients and prevent the
development of complications.
Conclusions
The conducted clinical observations and current la-
boratory-instrumental studies provide basis to claim that
hypertension combined with type 2 diabetes in the elderly
is a complex pathogenetic syntropy. Long-term course of
combined pathology, insufficiently effective results of stan-
dard therapy, modern challenges (military actions) lead to
the development of anxiety states, which significantly affects
the course of comorbid pathology in the elderly patients and
worsens the prognosis.
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Information about authors
Yurii Kazakov, MD, DSc, PhD, Professor, Head of the Department of Propaedeutics of Internal Medicine, Poltava State Medical University, Poltava, Ukraine; е-mail: kazakov.med.ua@gmail.com;
https://orcid.org/0000-0003-2224-851X
Oksana Muravlova, PhD, Associate Professor, Head of the Department of Endocrinology with Pediatric Infectious Diseases, Poltava State Medical University, Poltava, Ukraine; е-mail: endocrinology@pdmu.edu.ua,
o.muravlova@pdmu.edu.ua, mur_ov_pdmu@ukr.net; phone: +380(50)7619084; https://orcid.org/0000-0002-5319-7092
Tetiana Nastroga, PhD, Associate Professor at the Department of Internal Diseases and Emergency Medicine, Poltava State Medical University, Poltava, Ukraine; е-mail: t.nastroha@pdmu.edu.ua;
https://orcid.org/0000-0001-5347-6094
Oksana Kitura, PhD, Associate Professor at the Department of Internal Diseases and Emergency Medicine, Poltava State Medical University, Poltava, Ukraine; е-mail: o.kitura@pdmu.edu.ua;
https://orcid.org/ 0000-0001-5319-5831
S.V. Shut, PhD, Associate Professor at the Department of Propaedeutics of Internal Medicine, Poltava State Medical University, Poltava, Ukraine; е-mail: svetaumsa57@gmail.com; https://orcid.org/
0000-0003-0336-1891
Conicts of interests. Authors declare the absence of any conicts of interests and own nancial interest that might be construed to inuence the results or interpretation of the manuscript.
Information about funding. The work was carried out according to the initiative of the National Development and Reform Commission “Development of algorithms and technology for the introduction
of ahealthy lifestyle in patients with non-infectious diseases based on the study of functional status”. State registration number 0121U108237, without funding.
Authors’ contribution. Yu.M. Kazakov— study concept and design; O.V. Muravlova— nal approval of the article, material processing; T.V. Nastroga— text writing, data analysis; O.E. Kitura—
data analysis and interpretation; S.V. Shut— collection of material.

92
Vol. 20, No. 2, 2024Mìžnarodnij endokrinologìčnij žurnal,
ISSN 2224-0721 (print), ISSN 2307-1427 (online)
Оригінальні дослідження / Original Researches
Казаков Ю.М., Муравльова О.В., Настрога Т.В., Кітура О.Є., Шуть С.В.
Полтавський державний медичний університет, м. Полтава, Україна
Оптимізація лікування пацієнтів похилого віку з цукровим діабетом
та артеріальною гіпертензією в загальній практиці
Резюме.
Актуальність. Старіння населення стало провід-
ною демографічною ознакою України. За прогнозами Все-
світньої організації охорони здоров’я, кількість людей похи-
лого та старечого віку в найближчі десятиліття зросте майже
до 40 %. Артеріальна гіпертензія (АГ) і цукровий діабет (ЦД)
2-го типу є одними з головних факторів серцево-судинного
ризику. Відомо, що оксидантний стрес і субклінічне хронічне
системне запалення низької інтенсивності є визначальними
факторами ендотеліальної дисфункції, порушень реактив-
ності судин, підвищення периферичного судинного опору,
порушень вуглеводного і ліпідного обміну, що призводить
до зростання артеріального тиску і рівня глюкози в плаз-
мі крові. Мета: підвищити ефективність лікування та по-
кращити якість життя пацієнтів похилого віку з поєднаною
патологією (ЦД 2-го типу та АГ) за допомогою включення
емпагліфлозину та L-аргініну до базисної терапії. Матеріали
та методи. Під нашим спостереженням перебувало 50 осіб
похилого віку з коморбідною патологією: АГ ІІ ст., ішемічна
хвороба серця (функціональний клас ІІ) та ЦД 2-го типу
в стані субкомпенсації. Хворі були розподілені на дві групи.
Першій (контрольній) групі (n = 25) призначали загально-
прийняту базисну терапію. У другій (основній) групі (n = 25)
до базисної терапії додавали емпагліфлозин 10 мг/добу,
L-аргінін 300 мг/добу. Результати. Клінічне спостережен-
ня в амбулаторних умовах тривало протягом трьох місяців.
Комплексне лікування хворих похилого віку з коморбідною
патологією (АГ та ЦД 2-го типу) з додатковим включенням
емпагліфлозину та L-аргініну до базисної терапії сприяє
суттєвому позитивному впливу на клінічний перебіг, знижує
ризик прогресування цієї констеляції. Висновки. Застосуван-
ня запропонованої комплексної терапії в амбулаторно-полі-
клінічних умовах під контролем сімейного лікаря дозволить
суттєво покращити якість життя пацієнтів, попередити роз-
виток ускладнень.
Ключові слова:
артеріальна гіпертензія; цукровий діабет 2-го
типу; хворі похилого віку; емпагліфлозин; L-аргінін