ABSTRACT
Los eventos cardiovasculares representan la mayor complicación de la diabetes. La evidencia sugiere que la metformina mejora los resultados cardiovasculares en pacientes con diabetes, especialmente en el United Kingdom Prospective Diabetes Study (UKPDS) y otros estudios posteriores, por distintos mecanismos. Hay pocos estudios de seguridad cardiovascular para sulfonilureas aunque no tendrían un perfil seguro a este nivel. La gliclazida parece ser la de mejor performance de las drogas de este grupo. Algo similar ocurre con las meglitinidas, para las cuales los datos indican que no aumentarían el riesgo pero tampoco mejorarían la incidencia de eventos cardiovasculares. Las tiazolidinedionas son las drogas más cuestionadas, aunque los estudios y metaanálisis son contradictorios no habría dudas que aumentan el riesgo de insuficiencia cardíaca. Los inhibidores de la DPPIV mostraron resultados neutros a excepción de saxagliptina que aumentaría el riesgo de internación por insuficiencia cardíaca. Existen datos convincentes que los inhibidores de los receptores SGLT-2 a nivel renal y los análogos del GLP-1 intestinal tienen efectos positivos a nivel cardiovascular, con algunas diferencias entre los integrantes de esta familia. En cuanto a las insulinas, los estudios sugieren que tanto los análogos lentos como rápidos tendrían un mejor perfil cardiovascular, ligado principalmente a la menor incidencia de hipoglucemias severas, que insulina NPH y regular respectivamente.
Cardiovascular events represent the greatest complication of diabetes. Evidence suggests that metformin improves CV outcomes in patients with diabetes, especially in the United Kingdom Prospective Diabetes Study (UKPDS) and other subsequent studies, by different mechanisms. There are few cardiovascular safety studies for sulfonylureas although they would not have a safe profile at this level. Gliclazide appears to be the best performing drug in this group. Something similar occurs with meglitinides for which the data indicates that they would not increase the risk but neither would they improve the incidence of cardiovascular events. Thiazolidinediones are the most questioned drugs, although the studies and meta-analyzes are contradictory, there would be no doubt that they increase the risk of heart failure. DPPIV inhibitors showed neutral results except for saxagliptin, which would increase the risk of hospitalization for heart failure. There is convincing data that SGLT-2 receptor inhibitors at the renal level and intestinal GLP-1 analogues have positive effects at the cardiovascular level with some differences between the members of these families. Regarding insulins, studies suggest that both slow and fast analogues would have a better cardiovascular profile, mainly linked to the lower incidence of severe hypoglycemia, than NPH and regular insulin, respectively
Subject(s)
Humans , Diabetes Mellitus , Heart Failure , InsulinABSTRACT
O diabetes mellitus tipo 2 (DM2) apresenta alta prevalência, com aumento inclusive em crianças e adolescentes. A importância de um estrito controle glicêmico pode ser comprovada com a redução das complicações crônicas microvasculares. Já em relação à redução da doença macrovascular, principal causa de mortalidade nestes pacientes, são fundamentais o controle da glicemia, bem como de outros fatores de risco cardiovasculares, tais como hipertensão arterial, dislipidemia, peso, e a manutenção de hábitos saudáveis de vida. Temos vários medicamentos para o tratamento do DM2, sendo que a metformina é ainda a droga de primeira escolha, devido ao seu baixo custo e eficácia comprovada...
Type 2 diabetes mellitus (DM2) is highly prevalent and is increasing even in children and adolescents. The importance of strict glycemic control can be proven to reduce chronic microvascular complications. Regarding the reduction of macrovascular disease, the leading cause of mortality in these patients, it is essential tight glycemic control, as well as other cardiovascular risk factors, such as arterial hypertension, dyslipidemia, weight control, and maintaining healthy lifestyles. We have a lot of drugs for the treatment of DM2, and metformin is still the drug of first choice due to its low cost and proven effectiveness...
Subject(s)
Humans , Male , Female , /drug therapy , Metformin/therapeutic use , Administration, Oral , alpha-Glucosidases , Sulfonylurea Compounds/therapeutic use , Glycemic Index , Hypoglycemic Agents/administration & dosage , Incretins/therapeutic use , Glucagon-Like Peptide 1/agonists , Thiazolidinediones/therapeutic useABSTRACT
O diabetes mellitus tipo 2 (DM2) apresenta alta prevalência, com aumento inclusive em crianças e adolescentes. A importância de um estrito controle glicêmico pode ser comprovada com a redução das complicações crônicas microvasculares. Já em relação à redução da doença macrovascular, principal causa de mortalidade nestes pacientes, são fundamentais o controle da glicemia, bem como de outros fatores de risco cardiovasculares, tais como hipertensão arterial, dislipidemia, peso, e a manutenção de hábitos saudáveis de vida. Temos vários medicamentos para o tratamento do DM2, sendo que a metformina é ainda a droga de primeira escolha, devido ao seu baixo custo e eficácia comprovada.
Type 2 diabetes mellitus (DM2) is highly prevalent and is increasing even in children and adolescents. The importance of strict glycemic control can be proven to reduce chronic microvascular complications. Regarding the reduction of macrovascular disease, the leading cause of mortality in these patients, it is essential tight glycemic control, as well as other cardiovascular risk factors, such as arterial hypertension, dyslipidemia, weight control, and maintaining healthy lifestyles. We have a lot of drugs for the treatment of DM2, and metformin is still the drug of first choice due to its low cost and proven effectiveness.