Brain-derived neurotrophic factor — an innovative therapeutic vector in the treatment and prevention of cardiac autonomic neuropathy

Background. Even with modern therapeutic approaches, only a small proportion of patients with type 2 diabetes mellitus achieve effective metabolic control. The relevance of the work is due to the growing need for personalized management of patients with type 2 diabetes to prevent the development and progression of cardiac autonomic neuropathy (CAN). The purpose was to evaluate the effects of metformin, irbesartan, and alpha-lipoic acid (A-LA) on brain-derived neurotrophic factor (BDNF) levels and CAN in patients with type 2 diabetes. Materials and methods. Sixty people over 40 years of age with a verified diagnosis of type 2 diabetes mellitus who met the study criteria were examined and divided into three groups: group 1 (n = 20) received metformin alone at a daily dose of 2,000 mg; group 2 (n = 20) was assigned to combined treatment with metformin 2,000 mg/day and irbesartan 300 mg/day; group 3 (n = 20) received a combination of metformin 2,000 mg/day, irbesartan 300 mg/day and A-LA at a daily dose of 600 mg. According to the design of the scientific study, all patients underwent an assessment of basic anthropometric data, a set of laboratory examinations (glycated hemoglobin, BDNF level), clinical and instrumental diagnosis for the presence of CAN at the beginning and after 3 months of therapy. Results. The results of the regression analysis revealed a negative relationship between BDNF level and the presence of CAN with a value of B = –2.46 (95% confidence interval (CI): –3.80 to –1.12), p = 0.001; the influence of age (B = 0.05; 95% CI: 0.01–1.10; p = 0.017) and duration of type 2 diabetes (B = 0.09; 95% CI: 0.03–0.15; p = 0.002) on the development of CAN. After treatment, BDNF increased statistically significantly in all three groups (p ≤ 0.05). However, a decrease in the manifestations of CAN in terms of the total score was observed in the second and third groups. In the third group, two tests significantly improved, namely Valsalva and 30/15 (p ≤ 0.05), which indicates an improvement in the state of the parasympathetic nervous system. Conclusions. Low BDNF level is an early diagnostic marker of autonomic nervous system damage, particularly CAN in patients with type 2 diabetes. Effective potentiation of neuroprotective properties with simultaneous use of metformin, irbesartan, and A-LA has been confirmed.