Enfoque terapéutico de la diabetes mellitus tipo 2 en la Atención Primaria ante situaciones especiales

Introducción: Existe la necesidad imperiosa de individualizar cada tratamiento de diabetes mellitus tipo 2 según situaciones especiales de cada paciente diagnosticado con la enfermedad. Objetivo: Describir el enfoque terapéutico de los pacientes con diabetes tipo 2. Métodos: Se realizó un estudio descriptivo y trasversal en 96 pacientes diagnosticados con diabetes mellitus tipo 2, pertenecientes al policlínico Camilo Torres Restrepo, en el periodo de enero- diciembre 2021. Se estudiaron variables como la edad, sexo, tipo de tratamiento, tratamiento individualizado, control metabólico y adherencia al tratamiento. Se utilizaron técnicas de estadística descriptiva como frecuencia absoluta y porcentaje para variables cualitativas así como medidas de tendencia central para variables cuantitativas. Resultados: Hubo un predominio de las edades más avanzadas (por encima de 60 años) con el 72,9 % de la casuística y del sexo femenino (58,3 %). El 97,0 % de los participantes recibieron tratamiento farmacológico y no farmacológico, el 21,8 % necesitó más de un fármaco. La metformina fue el fármaco más utilizado (37,5 %). El tratamiento de los pacientes diabéticos en situaciones especiales fue inadecuado, excepto en pacientes con sobrepeso y obesidad, los pacientes que tuvieron adherencia al tratamiento, lograron un mejor control metabólico de la enfermedad (48 %). Conclusiones: El enfoque terapéutico en los pacientes estudiados fue inadecuado. El tratamiento de diabetes mellitus tipo 2 debe ser individualizado, desde un fundamento integral de la condición basal de cada paciente, al tener en cuenta sus comorbilidades para lograr una integralidad en las acciones en el nivel primario de prevención.

Introduction: There is an urgent need to individualize each diabetes mellitus type 2 treatment according to the special situations of each patient diagnosed with the disease. Objective: To describe the therapeutic approach of patients with diabetes type 2. Methods : A descriptive and cross-sectional study was carried out in 96 patients diagnosed with diabetes mellitus type 2, belonging to the Camilo Torres Restrepo polyclinic, in the period from January to December 2021. Variables such as age, sex, type of treatment, individualized treatment, metabolic control and adherence to treatment were studied. Descriptive statistical techniques were used, such as absolute frequency and percentage for qualitative variables, as well as measures of central tendency for quantitative variables. Results : There was a predominance of older ages (over 60 years) with 72.9 % of the casuistry and females (58.3 %). 97.0 % of the participants received pharmacological and non-pharmacological treatment, and 21.8% required more than one drug. Metformin was the most used drug (37.5 %). Treatment of diabetic patients in special situations was inadequate, except in overweight and obese patients, and patients who adhered to treatment achieved better metabolic control of the disease (48%). Conclusions : The therapeutic approach in the studied patients was inadequate. The treatment of diabetes mellitus type 2 must be individualized, from a comprehensive basis of the baseline condition of each patient, taking into account their comorbidities to achieve comprehensive actions at the primary level of prevention.

Metformin versus glyburide in treatment and control of gestational diabetes mellitus: a systematic review with meta-analysis

ABSTRACT Objective To compare the major outcomes of use of metformin and glyburide in treatment of gestational diabetes mellitus. Methods Studies published in English, in the last 10 years, in the databases MEDLINE®, SciELO, LILACS and Cochrane Library were analyzed, and randomized controlled trials were selected. Health Sciences Descriptors were used to compose the search phrase, and the keywords "Gestational diabetes", "Glyburide", "Metformin" and their variations were searched in the Medical Subject Headings. PRISMA systematization was used to prepare this review, and a meta-analysis was conducted aiming to mathematically show the results of fasting blood glucose, postprandial blood glucose, birth weight and weight gain during pregnancy after using metformin and glyburide. Results The studies evaluated birth weight, neonatal hypoglycemia, mode of delivery, need for intensive care, Apgar score, macrosomia, fasting glucose, postprandial glucose and weight gain during pregnancy. In 60% of studies, there were no statistically significant differences regarding safety and efficacy of administration of metformin and glyburide. Meta-analysis demonstrated the absence of statistical differences between these drugs in fasting blood glucose (p=0.821), postprandial blood glucose (p=0.217) and birth weight (p=0.194). However, significant differences were shown in weight gain during pregnancy (p=0.036). Conclusion The methods are effective, but the adverse effects of glyburide are more common; therefore, the use of metformin should be recommended, if in monotherapy.

The synergistic effect of metformin and anti-vascular endothelial growth factor in the treatment of diabetic retinopathy / 中华眼底病杂志

Objective To observe the synergistic effect of metformin and anti-vascular endothelial growth factor (VEGF) in the treatment of diabetic retinopathy.Methods This study was composed of clinical data review and in vitro cell experiment.Ten patients (12 eyes) with diabetic macular edema treated with antiVEGF drugs were included in the study.Patients were randomly divided into the VEGF group (anti-VEGF drug therapy) and the combined treatment group (anti-VEGF drug combined with metformin).The changes of visual acuity and central retinal thickness (CRT) were compared between the two groups.As far as the in vitro experiment was concerned,vascular endothelial cells were divided into the control group (normal cells),the VEGF group (50 ng/ml VEGF),the anti-VEGF group (50 ng/ml VEGF+2.5 μg/ml of conbercept),and the combined group (50 ng/ml VEGF +2.5 μg/ml of conbercept +2.0 mmol/L of metforrnin).And then MTT cell viability assay,scratch assay and real-time quantitative polymerase chain reaction assay were performed to analyze the cell viability,cell migration and mRNA level of VEGFR2,protein kinase C (PKC)-α and PKC-β successively.Results Review of clinical trial shows that the CRT recovery rates in the combined treatment group were much higher than that in the VEGF group at 3 month after the operation,while the difference was statistically significant (t=-2.462,P＜0.05).In vitro cell experiment results showed that VEGF induction upregulated the viability and mobility of vascular endothelial cells obviously compared with control group,at the same time,the use of anti VEGF drugs can effectively reverse the trend,in contrast,combination of metformin and anti-VEGF showed a more superior effect to some extent (P＜0.05).In the VEGF group,the mRNA expression of VEGFR2,PKC-αand PKC-[β were significantly increased compared with the control group (P＜ 0.01);while the mRNA expression of VEGFR2,PKC-αand PKC-β in the combination group decreased significantly compared with the VEGF group and the control group (P＜0.05).However,in the anti-VEGF group,the mRNA expression of VEGFR2,PKC-αand PKC-β were decreased,but has failed to reach the level of statistical learn the difference.Conclusions The combination ofmetformin and anti-VEGF drugs can reduce the CRT of diabetic retinopathy patients and inhibit the proliferation and migration of retinal vascular endothelial cells which induced by VEGF.The synergistic mechanism may be related to the inhibitory effect of metformin on the expression of VEGFR and PKC.

The change of PAI-1 and TNF-α in old patients with metabolic syndrome and the effect of metformin / 中国医师杂志

Objective To explore the correlation of PAI-1 and TNF-α and the pathophysiology of the metabolic syndrome (MS) and coronary heart disease,and explore the role of metformin in the MS.Methods Sixty cases of old patients with the MS were chosen.These patients were divided into two groups at random.One group interfered with living style and metformin,the other group only interfered with living style.The activity of PAI-1 was detected by chromogenic substrate method,and the level of TNF-α was detected by ELISA assay.Results (1) The levels of PAI-1 and TNF-α in the MS patients [(0.95 ± 0.05) AU/ml,(24.81 ± 3.87)ng/ml] were significantly higher than in normal old people[(0.66 ± 0.10)AU/ml,(10.76 ±2.00) ng/ml] (P ＜0.001) ;(2)The levels of PAI-1 and TNF-α in the MS patients with CHD [(0.96 ± 0.05) AU/ml,(26.12 ± 2.83) ng/ml] were significantly higher than those in the patients without CHD [(0.94 ± 0.03) AU/ml,(23.71 ± 4.27) ng/ml] (P ＜ 0.05) ;(3)The activity of PAI-1 and the level of TNF-α in the metformin group was decreased significantly [△ was (0.20 ± 0.17)AU/ml,(4.42 ± 0.85ng/ml),P ＜0.01],and metformin can improve the components of the MS.Conclusions The old patients with MS is prone to develop cardiac vascular disease.PAI-1 and TNF-α participate in pathophysiology of the MS and its complication.Metformin can inhibit the expression of PAI-1 and TNF-α to suppress the components of the MS,and block the complication of the MS.