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International journal of endocrinology 2 (74) 2016

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Impact оf Telmisartan оn the Quality оf Life іn Patients with Chronic Heart Failure аnd Diabetes Mellitus Type 2

Authors: Pavlyukovich N.D., Pavlyukovich O.V. - Higher State Educational Establishment of Ukraine «Bukovinian State Medical University», Chernivtsi, Ukraine

Categories: Endocrinology

Sections: Medical forums

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The article was published on p. 182-183


Diabetes mellitus (DM) — ​one of the leading medical-social problem of the modern society due to its high incidence, frequent comorbidity with concomitant pathology, increased mortality, high risk of chronic vessel complications. In Ukraine, same as in the world, the number of diabetic patients is continuously increasing mainly due to people with diabetes mellitus type 2, total number of which is around 90 % in the population of the patients with this disease (Pankiv V.I., 2010).

The aim of the study was to determine the impact of chronic heart failure and diabetes mellitus type 2 on the quality of life of elderly and senile patients.
Material and methods. A comprehensive survey of 108 patients with chronic heart failure (HF) of ischemic origin and DM type 2, who were hospitalized to the cardiological department of the Chernivtsi Regional Hospital for War Veterans, was conducted. The average age of the patients was 76.00 ± 1.84 years. All examined patients according to their comorbidities were randomized into the following subgroups: I — ​patients with HF without DM type 2 (n = 32), II — ​patients with HF, complicated by concomitant DM type 2 (n = 76). The control group for comparative studies comprised 24 people without HF and DM type 2, whose age was not significantly different from the average age of the patients of the experimental groups. All patients received basic therapy of the main and concomitant diseases. Moreover, to achieve the objective of the investigation telmisartan was prescribed additionally. Therefore, patients with HF and DM type 2 were randomized into subgroups according to the prescribed treatment: IIA subgroup — ​patients, who received only basic therapy (26 people); IIB subgroup (30 patients) — ​those, for whom in the scheme of the standard treatment substitution of ACE inhibitor by angiotensin II receptor blocker telmisartan (MIKARDIS®, Boehringer Ingelheim) was conducted. Telmisartan was prescribed in a daily dose of 40 mg after meals. Duration of hospital treatment was 21–24 days, in addition, it was recommended to continue treatment with telmisartan up to 3 months. Quality of life was determined by the questionnaire J.E. Mezzich, M. Cohen, N. Ruiperez et al., 1999.
Results. The level of physical welfare was highest in the patients of the control group (6.20 ± 0.56 points) dominating over the corresponding figure in the group of patients with chronic HF up to 1.37 times (4.50 ± 0.48 points, P < 0.05), and up to 2.82 times (2.20 ± 0.11 points, P < 0.05) — ​in patients with chronic HF and DM type 2. Value of the index of psychological and emotional welfare in the patients of the control group was 57 % more than in the patients with HF, its lowest value was determined in the patients of II group — ​2.10 ± 0.25 points, which differs significantly from the patients of the control group (P < 0.05) and the patients of the I group (P < 0.05). The lowest level of self-service and independence of activity was detected in the patients with chronic HF and DM type 2 (4.10 ± 0.14 points), being significantly different from the corresponding value in the group of patients with HF of ischemic origin (6.30 ± 1.11 points, P < 0.05), and the control group (9.40 ± 0.62 points, P < 0.05). Work ability index was higher in patients of both experimental groups, than in the patients of the control group. Thus, in the patients with isolated HF as well as in the patients with combined course of chronic HF and DM type 2 the difference between the corresponding values was statistically significant, same as comparing to the patients with control group (2.5 ± 0.6 points and 3.80 ± 0.09 points to 5.40 ± 1.08 points correspondingly, P < 0.05). The level of interpersonal interaction and socio-emotional support was statistically significantly lower in comparison with the control group only in the patients of II experimental group. The lower value of this figure in the patients with chronic HF was statistically improbable comparing with patients of control group. The level of public support in the patients of I experimental group was statistically improbably lower, than in the control group (6.40 ± 1.03 against 8.60 ± 0.65 points, P > 0.05). In the patients with chronic HF and DM type 2 the following figure was 4.60 ± 0.32 points, being statistically significantly different from the patients of the control group (P < 0.05). Figure of the personal implementation was the highest in the patients of control group (7.40 ± 0.64 points). Due to the chronic HF of ischemic origin its decreasing to 5.67 ± 0.52 points was determined, though we found no statistically significant difference comparing to the control group (p > 0.05). The lowest level of personal implementation was detected in the experimental II group of patients with HF and DM type 2 (2.8 ± 0.4 points, P < 0.05 comparing with both control and I group). Index of religious implementation was almost equal in all investigated groups. Comparing with the control group overall perception of quality of life in patients with chronic HF was lower by 23 %, and in patients with HF and DM type 2 — ​by 42 % respectively (P < 0.05 in both cases).
In the IIA experimental group during treatment we managed to achieve significant increasing of the figure of physical welfare by 59 % comparing with one before treatment (P < 0.001), psychological and emotional welfare — ​by 130 % (P < 0.001), workability — ​by 27 % (P < 0.02), overall perception of quality of life — ​by 13 % respectively (P < 0.02). At the same time, the inclusion of telmisartan to the scheme of the complex treatment resulted in the statistically significant improvement of the overall perception of the quality of life by 1.74 times (P < 0.001), particularly accompanied by improvement of physical welfare by 2.78 times against corresponding value before treatment (P < 0.001), psychological and emotional welfare — ​by 3.09 times (P < 0.001) and workability — ​by 1.56 times (P < 0.001), interpersonal interaction — ​by 1.33 times respectively (P < 0.02). In addition, in the patients of IIB group we have noted the improvement of the values of socio-emotional support by 67 % (P < 0.001), public support — ​by 24 % (P < 0.02) and personal realization — ​by 103 % (P < 0.001).
Conclusions. Inclusion of telmisartan to the scheme of complex treatment of the patients with chronic heart failure and diabetes mellitus type 2 results in the improvement of the patients’ quality of life as well as its main components.

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