**5. Subcutaneous and visceral fat**

MRI visualization of visceral fat dynamics demonstrated positive fat redistribution by lowering VFA in group I by 20.62 ± 13.54 cm2 (7.52%), р <0.001. In group II of metformin monotherapy, VFA decreased by 5.77 ± 3.75 cm2 (1.76%), р <0.001. SFA decreased by 4.51 ± 14.43 cm2 (1.69%), p < 0.05 in group I, and by 1.95 ± 1.05 cm2 (0.46%), p < 0.05 in group II. Significant improvement in SFA dynamic was observed in both groups; however, we have not detected

**Figure 5.** Dynamics of visceral and subcutaneous fat by results MRI. VF-visceral fat, SF- subcutaneous fat; \*P between groups >0.05; \*\*P between groups <0.05.

**7. Functional activity of β-cells and HOMA-IR**

**-30.47**

(11.08%), р > 0.05.

lin level decreased by 7.57%, (р <0.001).


Dynamics of

**Figure 6.** Dynamics of adipokines.

adipokines,

%

effect of Sitagliptin on the function of pancreatic β-cells.

Data from the analysis of pancreatic β-cell function condition have certain scientific and practical interest. For instance, in the Sitagliptin and metformin combined therapy group, a significant increase in HOMA-β index by 23.4 ± 22.6 relative units (33.06%), р <0.0001 was observed compared to the group that receiving metformin monotherapy, where increase in this index has not reached a statistical significance and equaled 4.86 ± 1.63 relative units

**Leptin Adiponectin**

**Sitaglipin+meormin Meormin**

**-5.41**

**27.06**

DPP-4 Inhibitors and Fat Metabolism in Patients with Type 2 Diabetes

**7.16**

http://dx.doi.org/10.5772/intechopen.72078

63

Furthermore, the work has obtained statistically significant insulin level lowering in both groups. For instance, on a background of Sitagliptin therapy in combination with metformin therapy, insulin level decreased by 15.68%, (р <0.001), and on metformin monotherapy, insu-

Before treatment, both groups showed increase in proinsulin level, after 6 months of therapy, we achieved significant decrease in the proinsulin level in group I (Sitagliptin + metformin) by 29.17%, (р <0.001), and in group II (metformin) by 13.79%, (p < 0.001). Proinsulin/insulin ratio is increased when the functional activity of β-cells is decreased and is an indication of more marked apoptosis in pancreatic β-cells. We established that on Sitagliptin therapy in combination with metformin, a significant decrease by 10.38%, (р <0.05) was observed in proinsulin/insulin ratio, while in metformin monotherapy group, a decrease in this ratio was insignificant, by 2.84%, (p > 0.05) (**Figure 7**). This should be considered as a long-term positive

It is important to note that on combined therapy С-peptide level increased by 55.83%, (р < 0.0001); and by 6.3%, (р < 0.05) in metformin monotherapy group. HOMA-IR significantly lowered in both groups. However, we have not detected statistically significant difference between the groups' dynamics. It decreased by 32% (р < 0.0001) in group I, and by 11.05% (р < 0.0001) in group II. The decrease in homeostasis model assessment of insulin resistance is the evidence of improvement in peripheral glucose disposal. Positive effect on β-cell function is associated with lowering of glucotoxicity, weight loss, insulin resistance, and improvement

statistically significant difference between the groups (**Figure 5**). VFA/SFA ratio significantly lowered by 0.18 ± 0.24 (15.26%), p < 0.001 in group I; and by 0.008 ± 0.008 (1.14%), p < 0.001 in group II, which is also indicative of more marked lowering of visceral fat in group I.
