Background. The obesity is found in 24.8 % (approximately 10 million people) and overweight in 34.3 % of the population of Ukraine, mainly in females. Obesity is associated with hereditary factors, overeating as well as a sedentary lifestyle. An integrated approach is applied to treat obesity such as combination of adequate eating behavior, high physical activity and administration of pharmacological correction, including glucagon-like peptide 1 agonist (GLP-1). Currently, the little is known about utility and effectiveness of GLP-1 in combination with adequate physical activity for obesity management among Ukrainian patients. The purpose of this study was to determine and evaluate the role of GLP-1 in combination with high physical activity for weight loss in obese patients and to compare with obese patients receiving treatment with metformin and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Materials and methods. A prospective study included 155 obese patients, and follow-up data were available of 49 patients. The study group GLP-1 consisted of 30 patients receiving combination therapy GLP-1 liraglutide in daily doses of 1.2 to 3 mg per day. The control group consisted of 19 patients receiving complex therapy with metformin in daily do­ses from 500 to 2000 mg, and SGLT2i in daily doses from 10 to 12.5 mg. Body mass index (BMI), waist circumference (WC), hip circumference (HC), and WC/HC ratio were evaluated. Number of daily steps was determined using pedometers built into smartphones or smartwatches. Evaluation of the obtained data was performed using non-parametric statistical methods. Results. In study group GLP-1 the mean weight before the treatment was 104.6 kg, after treatment 96.36 kg (p = 0.000007), the mean weight lost was 7.8 % (range 1–23.71 %) of initial body weight. Mean BMI before treatment was 37.1 kg/m2, after treatment 34.11 kg/m2 (p = 0.000006). In the control group, the mean weight before the treatment was 99.4 kg, after treatment 91.74 kg (p = 0.000196), the mean weight lost was 7.73 % (range 0–16.9 %) of initial body weight. Mean BMI before treatment was 35.6 kg/m2, after treatment 34.11 kg/m2 (p = 0.000196). Analyses of the entrie chorot showed that before treatment, the daily number of steps > 5000/day was determined in 25 (51 %) patients, after treatment in 48 (98 %); the daily number of steps > 10,000/day before treatment was determined in 6 (11 %) patients, after treatment it was 5 times more frequent in 31 (63 %) patients. These results indicate a significant intensification of physical activity, and high motivation for weight loss in both study groups. Conclusions. Our findings suggest that weight loss in obese people is effective in case of administration of GLP-1, metformin, SGLT2i in combination with high physical activities of daily steps > 5000, which is part of life style intervention.

Background. Obesity, prediabetes and type 2 diabetes mellitus (T2DM) are global diseases affecting the population of Ukraine, with an annual increase in morbidity. Insulin resistance occurs in up to 90 % of obese patients, contributing to the accumulation of white adipose tissue, and has a risk for the further development of prediabetes and T2DM. However, other factors also play a negative role in the development of obesity, particularly cholecalciferol (vitamin D) deficiency. Vitamin D is a steroid hormone the main function of which is to regulate calcium and phosphorus metabolism, but this molecule also exhibits va­rious properties, including the effects on carbohydrate metabolism. The purpose of this study was to identify and evaluate the role of vitamin D elevation in patients receiving glucagon-like peptide-1 agonists (GLP-1a) in combination with lifestyle interventions for the treatment of obesity and to compare its effectiveness with that in patients treating with metformin and sodium-glucose cotransporter 2 inhibitors (SGLT2i). Materials and methods. A prospective study included 155 obese patients, and follow-up data were available for 49 of them. The study group consisted of 30 patients receiving combination therapy with GLP-1a liraglutide at a dose of 1.2 to 3.0 mg per day. The control group included 19 patients recei­ving combination therapy with metformin in daily doses of 500 to 2,000 mg, and SGLT2i in daily doses of 10 to 12.5 mg. Treatment of vitamin D deficiency was performed with cholecalciferol at a dose of 4,000 IU/day. Results. In study group GLP-1a, 25 (83.3 %) patients had vitamin D insufficiency, which is statistically similar to control group (p > 0.05) — 17 (89.5 %) cases. All patients with vitamin D insufficiency received 4,000 IU of cholecalciferol daily during the follow-up period. In study group GLP-1a, the mean body mass before the treatment was 104.6 kg, after treatment — 96.36 kg (p = 0.000007), the mean weight lost was 7.8 % (range is 1–23.71 %) of the initial level. Mean body mass index (BMI) before treatment was 37.1 kg/m2, after treatment — 34.11 kg/m2 (p = 0.000006). In the control group, the mean weight before the treatment was 99.4 kg, after treatment — 91.74 kg (p = 0.000196), the mean weight lost was 7.73 % (range is 0–16.9 %) of the initial level. BMI before treatment averaged 35.6 kg/m2, after treatment — 34.11 kg/m2 (p = 0.000196). The analysis of carbohydrate metabolism parameters showed a significantly lower blood glucose level — 5.75 mmol/l in the study group GLP-1a compared to 8.42 mmol/l in the control group (p = 0.00024). It should be noted that a similar clinical picture was also observed after treatment, despite the compensation of T2DM in all patients: a significantly lower blood glucose level — 5.03 mmol/l in the study group GLP-1a compared to 5.99 mmol/l in controls (p = 0.002453). However, significantly higher levels of insulin were detected in the study group GLP-1a before treatment — 27.02 mU/L compared to 18.59 mU/L in control patients (p = 0.003286). After treatment, a similar situation was observed in terms of significantly higher levels of insulin: 19.41 mU/l in patients of the study group GLP-1a compared to 14.42 mU/l in controls (p = 0.0024). Corresponding changes were also observed for the HOMA index. Conclusions. Our results suggest high effectiveness of increasing the level of vitamin D in case of its insufficiency as a part of measures for the treatment of obese patients with liraglutide, metformin or SGLT2i.