Kikhtyak Olesya P. Pathogenetic targets of insulin resistance in type 2 diabetes mellitus and searching for its improvement

Comparative assessment of metformin, pyoglitazone and glimepiride influences on markers of insulin resistance of target tissues has been carried out clinically (patients with type 2 diabetes mellitus) and experimentally (streptozotocin-induced experimental diabetes in male Wistar rats). Due to pyoglitazone treatment the insulin level is reduced without significant changes of C-peptide, that witness about peripheral insulin binding ability with receptors and its diminishing in blood concentration. It has been revealed that reduction in the value of HOMA-IR index influenced by metformin is due to fasting glucose content decreasing caused by the oppression of glyuconeogenesis in the liver; while under the influence of pyoglitazone – the lowering of muscle and fatty tissue insulin resistance occurs. Pyoglitazone and glimepiride lead to the increase of the vascular adhesive molecule 1 content. Presence of reverse correlative link between the content of vascular adhesive molecule 1, fasting glucose level and HOMA-IR index, as well as direct correlation with concentration of adiponectin testifies for involvement of vascular adhesive molecule 1 in insulin resistance pathogenesis in patients with type 2 diabetes mellitus. The increase in the glucagon content on the background of metformin and glimepiride treatment has been revealed. In order to optimize the treatment of patients with type 2 diabetes mellitus a scheme of hypoglycemic drugs has been suggested, taking into consideration specificity of its action on insulin resistance in different tissues.