ABSTRACT
O diabetes melito tipo 2 (DM2) decorre de alteração na ação e secreção de insulina. A longo prazo, a elevação da glicemia promove dano microvascular, neuropatia e dano macrovascular, com consequente aumento da morbi-mortalidade destes pacientes. Nas últimas décadas, diversos ensaios clínicos clássicos demonstraram que intervenções terapêuticas específicas para corrigir a hiperglicemia e hipertensão arterial são capazes de prevenir ou retardar o avanço das complicações crônicas. Neste sentido, tratamento efetivo e da forma mais precoce possível deve ser oferecido a todos os pacientes com DM2. Fármacos antiobesidade e agentes orais, como a metformina, sulfonilureias, glinidas, tiazolidinedionas, inibidores da alfa-glicosidase, e os mais recentes fármacos incretinomiméticos e amilinomiméticos são apresentados nessa revisão, nos aspectos de mecanismos de ação, efeitos colaterais e contraindicações.
Type 2 diabetes mellitus (DM2) is caused by changes in the action and secretion of insulin. In the long term, increased glucose levels promote microvascular damage, neuropathy, and macrovascular damage, leading to higher morbidity and mortality in these patients. In recent decades, several clinical trials have demonstrated that specific therapeutic interventions to correct hyperglycemia and hypertension are able to prevent or delay the advance of chronic complications. In this sense, effective and early treatment should be offered to all patients with DM2. Antiobesity drugs and oral agents, such as metformin, sulfonylureas, glinides, thiazolidinediones, alpha-glucosidase inhibitors, and the most recent drugs (incretin mimetics and amilin mimetics) are analyzed in the present review with regard to their mechanisms of action, side effects, and contraindications.
Subject(s)
Humans , /drug therapy , Hyperglycemia/drug therapy , /complications , /diagnosis , /diet therapy , /prevention & control , /therapy , Hypoglycemic Agents/therapeutic use , Obesity/drug therapy , Inpatients , Treatment Outcome , Exercise Therapy/methods , Exercise TherapyABSTRACT
PURPOSE: Erectile dysfunction has variety of etiologic factors and it has been a common medical disorder with an estimated prevalence of about 50%. It has been confirmed that sildenafil improved impaired erectile responses in men. We evaluated the efficacy and safety of oral sildenafil for the patients with erectile dysfunction in Korea. MATERIALS AND METHODS: 583 patients were administered sildenafil for erectile dysfunction and 256 of them have been followed up over one month. The initial usual dosage was 50mg and the dosage was titrated based on efficacy and tolerance at every visit. Sexual function was measured before and during the therapy using International Index of Erectile Function (IIEF). RESULTS: Mean IIEF score changed significantly from 27.93+/-18.52 at baseline to 44.57+/-16.56 after treatment with sildenafil (p<0.001) and the mean scores of each IIEF domain (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) also improved (p<0.001). Q3 (penetration ability) and Q4 (maintenance ability) scores changed from 2.08+/-1.69 to 3.21+/-1.50 (p<0.001) and from 1.77+/-1.50 to 2.96+/-1.44 (p<0.001), respectively. In response to the global efficacy question, 73.4% of patients reported that treatment had improved their erections. With respect to the etiology, IIEF was changed significantly in DM group and no specific underlying disease group (p<0.001), but in radical prostatectomy or cystectomy group no significant change was observed. Side effects were reported in 56 patients (21.9%), including facial flushing (11.7%), headache (7.0%), dyspepsia (2.0%), altered vision (1.6%), nasal congestion (1.6%), conjunctival injection (1.2%), dyspnea (0.8%), dizziness (0.8%), and palpitation (0.8%). Only 4 patients (1.6%) discontinued treatment due to the side effects. CONCLUSIONS: Sildenafil citrate is a highly effective and well-tolerated oral agent for the treatment of erectile dysfunction in Korean men.