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1.
Int. j. med. surg. sci. (Print) ; 8(2): 1-14, jun. 2021. tab
Article in Spanish | LILACS | ID: biblio-1284430

ABSTRACT

En el nivel primario de atención se detectan errores en la prescripción del tratamiento farmacológico de la diabetes tipo 2. El objetivo de este estudio fue evaluar la calidad de la prescripción de hipoglucemiantes orales en pacientes atendidos en consultorios del médico de la familia del Policlínico Universitario Hermanos Cruz, municipio Pinar del Río, Cuba. Se realizó un estudio de utilización de medicamentos de tipo descriptivo y transversal clasificado dentro de estos como de indicación-prescripción con elementos de esquema terapéutico y de factores que condicionan los hábitos de prescripción. El universo estuvo conformado por 1575 pacientes con diagnóstico de diabetes mellitus tipo 2 tratados con hipoglucemiantes orales que pertenecían a los 20 consultorios médicos de la familia.La muestra de estudio se obtuvo por el método de muestreo no probabilístico (por conveniencia) (n=846). La información se obtuvo de la historia clínica y tarjeta control de los pacientes para adquirir estos medicamentos. Predominó la edad de 40-49 años, el sexo femenino y entre 5-10 años de evolución de la enfermedad. No se usó la primera línea de tratamiento en el 43,6 % de los casos, ningún caso tenía estudios de laboratorio para el uso de la Metformina. La prescripción y dosis fue adecuada no así su uso racional. Las interacciones más frecuentes fueron las farmacocinéticas.El uso racional de hipoglucemiantes orales fue deficiente lo que hace necesario ampliar la divulgación de un protocolo de tratamiento para mejorar el uso de estos fármacos en el nivel primario de atención.


Errors in the prescription of drug treatment for type 2 diabetes are detected at the primary level of care. the purpose of this study was to evaluate the quality of the prescription of oral hypoglycemic agents in patients attended in the family doctor's offices of the Hermanos Cruz University Polyclinic, Pinar del Río distrit, Cuba. A descriptive and cross-sectional study of the use of medications was carried out, classified within these as indication-prescription with elements of the therapeutic scheme and factors that condition prescription habits. The universe was made up of 1575 patients diagnosed with type 2 diabetes mellitus treated with oral hypoglycemic agents who belonged to the 20 family medical offices. The study sample was carried out by the non-probabilistic sampling method (for convenience) (n = 846). The information was obtained from the clinical history and control card of the patients to acquire these medications. The age of 40-49 years, the female sex and between 5-10 years of evolution of the disease predominated. The first line of treatment was not used in 43.6% of the cases; no case had laboratory studies for the use of Metformin. The prescription and dose was adequate, but not its rational use. The most frequent interactions were pharmacokinetic ones.The rational use of oral hypoglycemic agents was deficient, which makes it necessary to expand the dissemination of a treatment protocol to improve the use of these drugs at the primary level of care.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Drug Prescriptions , Primary Health Care , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Outcome and Process Assessment, Health Care , Socioeconomic Factors , Sex Factors , Cross-Sectional Studies , Administration, Oral , Age Factors , Cuba , Drug Interactions , Drug Utilization
2.
Bol. latinoam. Caribe plantas med. aromát ; 20(2): 132-146, 2021. ilus, tab
Article in English | LILACS | ID: biblio-1342208

ABSTRACT

We investigated the effects of dichloromethane extract (DME) from Myrcia splendenson alterations caused by type 2 diabetes in the blood and kidney of rats, in order to reduce side effects caused by synthetic drugs. Rats received streptozotocin (60 mg/kg),15 minutes after nicotinamide (120 mg/kg) or water. After 72 hours, the glycemic levels were evaluated to confirm diabetes and the animals received (15 days) DME (25, 50, 100 or 150 mg/Kg) or water. DME partially reversed hyperglycemia and (100 and 150 mg/kg) reversed hypertriglyceridemia. Histopathological findings elucidated that DME reduced damage to pancreatic islets. DME 150 mg/kgreversed the increases in TBA-RS, the reduction in the sulfhydryl content, 100 and 150 mg/kg increased CAT, reversed the decrease in GSH-Px and increased it activity in the blood. DME 150 mg/kg reversed CAT and GSH-Px reductions in the kidney. We believe that DME effects might be dependent on the presence of phenolic compounds.


Investigamos los efectos del extracto de diclorometano (DME)de Myrcia splendens sobre las alteraciones causadas por la diabetes tipo 2 en la sangre y los riñones de las ratas, para reducir los efectos secundarios causados por las drogas sintéticas. Las ratas recibieron estreptozotocina (60 mg/kg), 15 minutos después de la nicotinamida (120 mg/kg) o agua. Después de 72 horas, se confirmo la diabetes y los animales recibieron (15 días) DME (25, 50, 100 o 150 mg/Kg) o agua. DME revierte parcialmente la hiperglucemia y revierte la hipertrigliceridemia. DME redujo el daño a los islotes pancreáticos. DME revirtió los aumentos en TBA-RS, la reducción en el contenido de sulfhidrilo, aumentó la CAT, revirtió la disminución en GSH-Px y aumentó su actividad en la sangre. Además, DME revirtió las reducciones de CAT y GSH-Px en el riñón. Creemos que los efectos provocados por DME pueden depender de la presencia de compuestos fenólicos.


Subject(s)
Animals , Male , Rats , Plant Extracts/administration & dosage , Myrtaceae/chemistry , Diabetes Mellitus, Experimental/drug therapy , Hypoglycemic Agents/administration & dosage , Methylene Chloride/administration & dosage , Blood Glucose/drug effects , Plant Extracts/chemistry , Chromatography, High Pressure Liquid , Rats, Wistar , Streptozocin , Oxidative Stress/drug effects , Spectrometry, Mass, Electrospray Ionization , Phenolic Compounds/analysis , Hypolipidemic Agents/administration & dosage , Antioxidants/administration & dosage
3.
Arch. endocrinol. metab. (Online) ; 64(3): 290-297, May-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1131087

ABSTRACT

ABSTRACT Objective To evaluate the use of metformin for preventing cesarean deliveries and large-for-gestational-age (LGA) newborn (NB) outcomes in non-diabetic obese pregnant women. Subjects and methods This is a randomized clinical trial with obese pregnant women, divided into 2 groups: metformin group and control group, with followed-up prenatal routine. The gestational age of participants was less than or equal to 20 weeks and were monitored throughout entire prenatal period. For outcomes of delivery and LGA newborns, absolute risk reduction (ARR) and the number needed to treat (NNT) were calculated with a 95% confidence interval (CI). Results 357 pregnant women were evaluated. From the metformin group (n = 171), 68 (39.8%) subjects underwent cesarean delivery, and 117 (62.9%) subjects from the control group (n = 186) had intercurrence (p < 0.01). As for the mothers' general characteristics, there was significance for marital status (p < 0.01). Maternal-fetal results presented reduced preeclampsia (p < 0,01). Primary prophylactic results presented an ARR of 23.1 times (95% CI: 13.0-33.4) with NNT of 4 (95% CI: 3.0-7.7) and no significant values for LGA NB (p > 0.01). Secondary prophylactic outcomes presented decreased odds ratio for preeclampsia (OR = 0.17, 95% CI: 0.10-0.41). Conclusion The use of metformin reduced cesarean section rates, resulted in a small number of patients to be treated, but it did not reduce LGA NB. Administering a lower dosage of metformin from the early stages to the end of treatment may yield significant results with fewer side effects. Arch Endocrinol Metab. 2020;64(3):290-7


Subject(s)
Humans , Female , Pregnancy , Adult , Pregnancy Complications/drug therapy , Cesarean Section/statistics & numerical data , Hypoglycemic Agents/administration & dosage , Metformin/administration & dosage , Obesity/drug therapy , Socioeconomic Factors , Case-Control Studies
4.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 334-337, Mar. 2020. tab
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136205

ABSTRACT

SUMMARY OBJECTIVE To present the results of metabolic control in patients with type 2 Diabetes Mellitus from a private clinic in Northern Mexico, METHODS This cross-sectional study used retrospective data obtained from electronic records from a private outpatient clinic at the end of 2018. Inclusion criteria were a diagnosis of T2DM and age ≥ 18 years. Baseline characteristics (age, gender, drug use) were reported. The achievement of glycated hemoglobin goals was established as <7%. RESULTS A total of 3820 patients were evaluated. Their mean age was 59.86 years (+/-15.01). Of the population, 46.72% were men, and 53.28% were women. Glycated hemoglobin goals were adequate in 1872 (54%) patients. There were 3247 patients (85%) treated with oral medications, of which 1948 (60%) reported glycated hemoglobin less than 7%. Insulin use was reported in 573 (15%) patients, with 115 (20%) reporting glycated hemoglobin less than 7%. The most frequently used basal insulin was glargine in 401 (70%) patients. CONCLUSIONS Our findings are clearly higher than the control rate reported by our national health surveys of 25% with glycated hemoglobin < 7%, but similar to that reported in other countries. The most commonly used therapeutic scheme was the combination of oral hypoglycemic agents. The percentage of cases that include insulin in their treatment was lower. Clinical inertia to insulin initiation and intensification has been defined as an important cause of this problem.


RESUMO OBJETIVO Apresentar os resultados do controle metabólico de pacientes com Diabetes Mellitus tipo 2 em uma clínica privada no norte do México, MÉTODOS Este estudo transversal utilizou dados retrospectivos obtidos em prontuários eletrônicos de um ambulatório privado no final de 2018. Os critérios de inclusão foram o diagnóstico de DM2 e idade ≥ 18 anos. Características basais (idade, sexo, uso de drogas) foram relatadas. A realização de metas de hemoglobina glicada foi estabelecida como <7%. RESULTADOS Um total de 3820 pacientes foram avaliados. A média de idade foi de 59,86 anos (+/- 15,01). Da população, 46,72% eram homens e 53,28% eram mulheres. Objetivos de hemoglobina glicada foram adequados em 1872 (54%) pacientes. Havia 3247 pacientes (85%) tratados com medicamentos orais relatando em 1948 (60%) menos de 7%. O uso de insulina foi relatado em 573 (15%) pacientes, com 115 (20%) relatando menos de 7%. A insulina basal mais utilizada foi a glargina, em 401 (70%) pacientes. CONCLUSÕES Nossos resultados são claramente mais altos do que a taxa de controle relatada por nossos levantamentos nacionais de saúde de 25% com hemoglobina glicada <7%, mas semelhante à relatada em outros países. O esquema terapêutico mais utilizado foi a combinação de hipoglicemiantes orais. A porcentagem de casos que incluem insulina no tratamento foi menor. A inércia clínica à iniciação e intensificação da insulina tem sido definida como uma importante causa desse problema.


Subject(s)
Humans , Male , Female , Adult , Aged , Diabetes Mellitus, Type 2/metabolism , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Glycated Hemoglobin A , Cross-Sectional Studies , Retrospective Studies , Drug Therapy, Combination , Insulin Glargine/administration & dosage , Mexico , Middle Aged
5.
Rev. Bras. Saúde Mater. Infant. (Online) ; 20(1): 7-16, Jan.-Mar. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136406

ABSTRACT

Abstract Objectives: identify the action of metformin and physical activities to reduce weight gain and prevent mellitus diabetes in obese pregnant women. Methods: the electronic search was performed in PubMed / MEDLINE, LILACS, Web of Science, Scopus and Cochrane library databases between 2008 and 2018. The selection took place between April and July 2018, through the descriptors "pregnancy, obesity, metformin, treatment, exercise". A protocol was programmed and consecutively a selective research on the inclusion / exclusion phase. The "PICO" strategy was used. Population: obese pregnant women. Intervention: physical exercises and metformin. Control: The main indicator established was therapeutic outcomes with physical activity and metformin. Outcome of interest: body weight control. Results: by selecting the database, 3,983 articles were identified on the topic of interest. After selecting and eligibility, only 16 scientific studies were selected, of which 81.25% were clinical trials related to diet programs, physical activity, metformin use and possible outcomes, 18.75% were prospective cohort on causes of obesity in gestation and its association with gestational mellitus diabetes and preventive therapies. The study pointed out the possibility of adapting physical therapy programs with the correct metformin dosage for a greater control in gestational weight gain. However, there is a need for greater awareness and changes in habits for obese woman during the gestational period. Conclusions: the drug presents similarity to physical activity by activating AMPK and may be added to treatments that propose changes in pregnant women's lifestyle to reduce weight gain and prevent gestational diabetes mellitus with a better understanding of the optimal dosage. Thus, the study suggests the use of metformin is not only for the prevention and the intercurrence of gestational diabetes mellitus, but a strictly careful investigation allowing its use to non-diabetic obese pregnant women.


Resumo Objetivos: identificar a ação da metformina e da atividade física para redução do ganho de peso e prevenção do diabetes mellitus em gestantes obesas. Métodos: a busca eletrônica foi realizada nas bases de dados PubMed/MEDLINE, LILACS, Web of Science, Scopus e biblioteca Cochrane entre 2008 e 2018. A seleção ocorreu entre abril e julho de 2018, através dos descritores "gravidez, obesidade, metformina, tratamento, exercício". Programou-se um protocolo e consecutivamente uma etapa seletiva de inclusão/exclusão das pesquisas. Utilizou-se a estratégia "PICO". População: gestantes obesas. Intervenção: exercícios fisicos e metformina. Controle: o principal comparador estabelecido foi o desfecho terapêutico com atividade fisica e metformina. Desfecho de interesse: controle do peso corporal. Resultados: através da seleção do banco de dados, 3.983 artigos foram identificados sobre o tema de interesse. Após as etapas de seleção e elegibilidade, apenas 16 estudos científicos foram selecionados, dos quais 81,25% ensaios clinicos referentes aos programas de dieta, atividade física, uso da metformina e possíveis desfechos, 18,75% coorte prospectiva sobre as causas da obesidade na gestação e sua associação com o diabetes mellitus gestacional e terapêutica preventiva. O estudo apontou a possibilidade de se adequar programas de terapias físicas com a dosagem correta de metformina para um maior controle no ganho de peso gestacional. No entanto, existe a necessidade de uma maior concientização e mudanças de hábitos da mulher obesa durante o período gestacional. Conclusões: a droga apresenta semelhança com a atividade física ao ativar o AMPK e pode somar aos tratamentos que propõem mudanças no estilo de vida das gestantes para reduzir o ganho de peso e prevenir o diabetes mellitus gestacional com a necessidade de um melhor entendimento sobre a dosagem ideal. Desta forma, o estudo sugere que o uso da metformina não seja apenas para prevenção e intercorrências do DMG, mas também com uma investigação estritamente cuidadosa para possibilitar o seu uso em grávidas obesas não diabéticas.


Subject(s)
Humans , Female , Pregnancy , Exercise , Diabetes, Gestational/prevention & control , Gestational Weight Gain , Obesity, Maternal/complications , Hypoglycemic Agents/administration & dosage , Metformin/therapeutic use
6.
Arch. endocrinol. metab. (Online) ; 64(1): 82-88, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088767

ABSTRACT

ABSTRACT Objective The insulin tolerance test (ITT) has been accepted as the gold standard test for assessing the integrity of the growth hormone (GH) - insulin-like growth factor (IGF-1) axis and the hypothalamic-pituitary-adrenal (HPA) axis. The goal of the test is to achieve clinical and biochemical hypoglycemia at a blood glucose level ≤ 40 mg/dL to effectively and correctly assess the HPA and GH-IGF-1 axes. In this study, the GH and cortisol responses of patients who achieved and failed to achieve biochemical hypoglycemia during an ITT were compared. Subjects and methods One hundred thirty-five patients with pituitary disorders were included in the study. Samples for blood glucose levels were obtained after clear symptoms of clinical hypoglycemia developed. The patients were enrolled in the hypoglycemic and nonhypoglycemic groups according to whether their plasma glucose level ≤ 40 mg/dL or > 40 mg/dL during an ITT, and the groups were compared in terms of their GH and cortisol responses. Results The mean age, body mass index and waist circumference of the two patient groups were found to be similar. The mean blood glucose level was significantly lower in the hypoglycemic group than in the nonhypoglycemic group (19.3 and 52.0 mg/dL, respectively). When the two groups were compared in terms of peak cortisol and GH responses, no statistically significant differences were found. Conclusion The data presented suggest that clinically symptomatic hypoglycemia is as effective as biochemically confirmed hypoglycemia during an ITT. Arch Endocrinol Metab. 2020;64(1):82-8


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Insulin-Like Growth Factor I/analysis , Hydrocortisone/blood , Human Growth Hormone/blood , Glucose Tolerance Test/methods , Hypoglycemia/blood , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pituitary-Adrenal System/metabolism , Blood Glucose Self-Monitoring , Retrospective Studies , Glucose Tolerance Test/adverse effects , Hypoglycemia/diagnosis , Hypoglycemia/metabolism , Hypothalamo-Hypophyseal System/metabolism
7.
Braz. j. med. biol. res ; 53(1): e8652, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055481

ABSTRACT

Glycemic variability (GV) may be linked to the development of diabetic complications by inducing inflammation, oxidative stress, and endothelial dysfunction. Flash glucose monitoring (FGM) provides a novel method of continuously monitoring interstitial glucose levels for up to 14 days. This study randomly assigned poorly controlled type 2 diabetes mellitus patients treated with metformin and multiple daily injections of insulin (n=60) to either continuous subcutaneous insulin infusion (CSII) treatment or CSII in combination with liraglutide (CSII+Lira) treatment for 14 days during hospitalization. GV was assessed using a FGM system; weight and cardiometabolic biomarkers were also evaluated. The coefficient of variation was significantly reduced in the CSII+Lira group (P<0.001), while no significant change was observed in the CSII group. The changes differed significantly between the two groups in mean amplitude of glycemic excursions (P=0.004), standard deviation (P=0.006), and the percentage of time in the target range (4-10 mmol/L, P=0.005 and >10 mmol/L, P=0.028). The changes in mean of daily differences, interquartile range, and percentage of time in hypoglycemia (<3.3 mmol/L) and hyperglycemia (>13.9 mmol/L) identified by FGM showed no difference. Treatment with liraglutide increased serum adiponectin [33.5 (3.5, 47.7) pg/mL, P=0.003] and heme oxygenase-1 levels [0.4 (-0.0, 1.8) ng/mL, P=0.001] and reduced serum leptin levels [-2.8 (3.9) pg/mL, P<0.001]. Adding the glucagon-like peptide-1 analog liraglutide improved GV, weight, and some cardiometabolic risk markers. The FGM system is, therefore, shown to be a novel and useful method for glucose monitoring.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Insulin Infusion Systems , Blood Glucose Self-Monitoring/methods , Diabetes Mellitus, Type 2/drug therapy , Liraglutide/administration & dosage , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Pilot Projects , Diabetes Mellitus, Type 2/blood
8.
Arch. endocrinol. metab. (Online) ; 63(5): 478-486, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038500

ABSTRACT

ABSTRACT Objectives To provide a meta-analysis of the clinical efficacy and safety of sodium glucose co-transporter 2 inhibitors (SGLT2-i), as a combination treatment with metformin in type 2 diabetes mellitus (T2DM) patients with inadequate glycemic control with metformin alone. Materials and methods We have searched randomized controlled trials (RCTs) in the database: MEDLINE, Embase and Cochrane Collaborative database. We used mean differences (MD) to assess the efficacy of glycemic and other clinical parameters, and risk ratios (RR) to evaluate the adverse events for safety endpoints. The heterogeneity was evaluated by I2. Results Finally 9 studies were included. SGLT2-i plus metformin had higher reduction level in HbA1C [MD = -0.50, 95% CI (-0.62, -0.38), p < 0.00001], FPG [MD = -1.12, 95%CI (-1.38, -0.87), p < 0.00001], body weight [MD = -1.72, 95% CI (-2.05, -1.39), p < 0.00001], SBP [MD = -4.44, 95% CI (-5.45, -3.43), p < 0.00001] and DBP [MD = -1.74, 95% CI (-2.40, -1.07), p < 0.00001] compared with metformin monotherapy. However, SGLT2-i plus metformin group had higher risk of genital infection [RR = 3.98, 95% CI (2.38, 6.67), p < 0.00001]. No significant difference was found in the risk of hypoglycemia, urinary tract infection or volume related adverse events. Conclusions Although the risk of genital infection may increase, SGLT2-i plus metformin may provide an attractive treatment option to those T2DM patients who are unable to achieve glycemic control with metformin alone, based on its effects on glycemic control, reducing body weight and lowering blood pressure.


Subject(s)
Humans , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/administration & dosage , Metformin/administration & dosage , Randomized Controlled Trials as Topic , Drug Therapy, Combination , Sodium-Glucose Transporter 2 Inhibitors/administration & dosage
9.
Medicina (B.Aires) ; 79(4): 241-250, ago. 2019. ilus, graf, tab
Article in Spanish | LILACS | ID: biblio-1040516

ABSTRACT

La diabetes mellitus tipo 2 tiene evolución crónica y progresiva, prevalencia creciente y aún es diagnosticada tardíamente. Esto conlleva mayor incidencia de complicaciones crónicas, con incremento de costos en salud. Existe retraso en el inicio de insulinoterapia por causas relacionadas tanto al paciente como al médico. A pesar de los avances en su tratamiento, una baja proporción de enfermos logra control glucémico adecuado. La alta prevalencia de hipoglucemia en pacientes insulino-tratados, impulsó el desarrollo de una nueva generación de insulinas basales de acción prolongada, mayor estabilidad con menor variabilidad y riesgo de hipoglucemias. El programa EDITION evaluó la eficacia y seguridad de glargina U300 vs. glargina U100 en pacientes con diabetes tipo 1 y 2, en distintas etapas de la enfermedad. Glargina U300 es una nueva formulación de insulina glargina con perfil farmacocinético y farmacodinámico más estable y prolongado que glargina U100. Glargina U300 demostró eficacia y tolerabilidad comparable a glargina U100, con descenso significativo del riesgo de hipoglucemias nocturnas y en 24 horas, aportando mayor flexibilidad en el horario de inyección, con una ventana de 6 horas. Además, no se observó mayor aumento de peso que con glargina U100. El estudio Bright (2018) comparó glargina U300 vs. degludec U100, demostrando mayor beneficio en relación al riesgo de hipoglucemia con Gla-300 durante el período de titulación. Gla-300 es una insulina basal de última generación, disponible para mejorar el control metabólico, con menor riesgo de hipoglucemia.


Type 2 diabetes is a chronic, progressive disease with increasing prevalence and still late diagnostic. This leads to an increase in the incidence of chronic complications, with signifi cantly increasing health costs. There is also a delay in the onset of insulin therapy in patients with type 2 diabetes for causes related to both patients and physicians. Despite advances in treatment, a low proportion of patients achieve adequate glycemic control. The high hypoglycemia prevalence, consequence of insulin, has led to the development of a new generation long-acting basal insulins to achieve a more stable and prolonged action profile, reducing the variability and risk of hypoglycemia. The EDITION program evaluated the efficacy and safety of glargine U300 compared to glargine U100 in patients with type 1 and 2 diabetes at different stages of the disease. Gla-300 is a new formulation of insulin glargine which has a more stable and prolonged pharmacokinetic and pharmacodynamic profile. Gla-300 demonstrated efficacy and tolerability comparable to glargine U100, with a significant decrease in the risk of hypoglycemia, at night and in 24 hours, providing greater flexibility in the injection schedule, with a window of 6 hours. No increase in weight was observed compared to glargine U100. Bright study (2018) compared glargine U300 vs. degludec U100, demonstrating greater benefit in relation to the risk of hypoglycemia with Gla-300 during titration period. Gla-300 is a last-generation basal insulin, available to improve metabolic control, with a lower risk of hypoglycemia.


Subject(s)
Humans , Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 2/drug therapy , Insulin Glargine/administration & dosage , Insulin Glargine/pharmacokinetics , Hypoglycemic Agents/administration & dosage , Evidence-Based Medicine , Insulin Glargine/adverse effects , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/pharmacokinetics
10.
Gac. méd. Méx ; 155(2): 156-161, mar.-abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1286477

ABSTRACT

Resumen Introducción: Poco se ha evaluado el rechazo de los médicos a prescribir insulina a sus pacientes; el retraso en intensificar el tratamiento impide una atención adecuada y de calidad. Objetivo: Identificar la percepción de los médicos acerca de las barreras para iniciar la insulina en los pacientes con diabetes. Método: Por Índice Smith y análisis multivariado, en 81 médicos familiares se evaluó la relevancia y agrupación de los conceptos relacionados con las barreras para la prescripción de insulina. Resultados: 35.8 % de los médicos mostró confianza en prescribir insulina; casi la mitad calificó la intensificación del tratamiento entre moderadamente y poco importante (39.5 y 6.2 %). Las barreras se relacionaron con el médico (39.5 %), el paciente (37 %), el tratamiento con insulina (11.1 %) y la institución (6.2 %); 6.2 % de los médicos no percibió ninguna barrera. Las barreras se agruparon en cinco factores, que explicaron 62.48 % de la varianza: cultura de los pacientes, falta de habilidades, miedo a los eventos adversos, inseguridad y falta de capacitación. Conclusión: La inercia clínica no resultó de una condición clínica compleja o comorbilidades del paciente, sino de la percepción del médico y de su confianza en sus habilidades clínicas y comunicativas.


Abstract Introduction: Refusal of physicians to prescribe insulin to their patients has been scarcely evaluated; the delay in treatment intensification hinders adequate and quality care. Objective: To identify the perception of primary care physicians about barriers to initiate insulin treatment in patients with diabetes. Method: Using the Smith Index and multivariate analysis, the relevance and grouping of concepts related to barriers to insulin prescription were assessed in 81 family doctors. Results: Only 35.8% of physicians showed confidence for prescribing insulin; almost half of them rated treatment intensification between moderately and little important (39.5% and 6.2%). Barriers were related to the physician (39.5%), the patient (37%), insulin treatment (11.1%) and the institution (6.2%); 6.2 % of physicians did not perceive any barrier. The barriers were grouped in 5 factors that explained 62.48% of the variance: patient cultural level, lack of medical skills, fear of adverse events, insecurity and lack of training. Conclusion: Clinical inertia was not the result of a complex medical condition or patient comorbidities, but of doctor’s perception and confidence in his/her clinical and communication skills.


Subject(s)
Humans , Male , Female , Middle Aged , Practice Patterns, Physicians'/statistics & numerical data , Physicians, Primary Care/statistics & numerical data , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Quality of Health Care , Attitude of Health Personnel , Clinical Competence , Communication , Diabetes Mellitus, Type 2/drug therapy
12.
Ciênc. Saúde Colet ; 24(3): 997-1005, mar. 2019. tab
Article in Portuguese | LILACS | ID: biblio-989579

ABSTRACT

Resumo Investigar os fatores associados ao controle glicêmico de pessoas com diabetes mellitus (DM). Estudo transversal realizado com 746 pessoas com DM tipo 2 e 40 anos ou mais de idade. Elegeu-se as seguintes variáveis: socioeconômicas, dados clínicos, estilo de vida e o risco para o desenvolvimento de úlceras nos pés. A coleta dos dados ocorreu por meio de entrevista, análise do prontuário e exame clínico dos membros inferiores. Utilizou-se o modelo de regressão múltipla de Poisson para determinação das razões de prevalência (RP) brutas e ajustadas da alteração do exame de hemoglobina glicada (HbA1c), considerada como variável dependente desta pesquisa, sendo esta classificada como elevada quando o valor apresentava resultado superior a 7%. Identificou-se a elevação da HbA1c em 68,9% dos participantes e foi mais prevalente em indivíduos com idade entre 50 e 69 anos (RP = 1,38/IC95% = 1,09-1,75), os que faziam uso de insulina (RP = 1,35/IC95% = 1,24-1,47), obesos (RP = 1,14/IC95% = 1,03-1,25) e naqueles que possuíam risco de ulceração nos pés (RP = 1,14/IC95% = 1,09-1,28). Os indivíduos na faixa etária entre 50 e 69 anos, os que faziam uso de insulina, os obesos e os que possuíam risco de ulceração nos pés apresentaram maiores taxas de prevalência de alteração na hemoglobina glicada.


Abstract Investigate the factors associated with the glycemic control in people with diabetes mellitus (DM). Cross-sectional study with 746 people with type-2 DM of age 40 or older. The following variables were selected: socioeconomic, clinical data, lifestyle and the risk of developing foot ulcers. Data collection occurred through interviews, medical record analysis and clinical examination of the lower limbs. We used the Poisson multiple regression model to determine the crude and adjusted prevalence ratios (PR) of the glycemic alteration. The alteration in the glycated hemoglobin (HbA1c) test was considered as a dependent variable in this study, which has been classified as high when the result was higher than 7%. The alteration in HbA1c was present in 68.9% of the participants and was more prevalent in individuals aged between 50 and 69 (PR = 1.38/IC95% = 1.09-1.75), who were taking insulin (PR = 1.35/IC95% = 1.24-1.47), obese (PR = 1.14/IC95% = 1.03-1.25) and who had foot ulceration risk (PR = 1.14/IC95% = 1.09-1.28). Individuals aged between 50 and 69; the ones who used insulin; the obese ones; and those who had a risk of foot ulceration, presented higher prevalence rates of alteration in the glycated hemoglobin.


Subject(s)
Humans , Male , Female , Adult , Aged , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/epidemiology , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Socioeconomic Factors , Glycated Hemoglobin A/metabolism , Poisson Distribution , Prevalence , Cross-Sectional Studies , Interviews as Topic , Diabetic Foot/epidemiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Life Style , Middle Aged , Obesity/epidemiology
13.
Rev. Assoc. Med. Bras. (1992) ; 65(1): 33-37, Jan. 2019. tab
Article in English | LILACS | ID: biblio-985003

ABSTRACT

SUMMARY OBJECTIVE To investigate the clinical efficacy and the possible mechanisms of saxagliptin in the treatment of type 2 diabetes mellitus (T2DM) combined with non-alcoholic fatty liver disease (NAFLD). METHODS A total of 95 T2DM and NAFLD patients were randomly divided into group A (saxagliptin group), group B (glimepiride group), and group C (glimepiride combined with polyene phosphatidylcholine group). RESULTS After intervention treatment for 24 w, body mass index (BMI), waist-to-hip ratio (WHR), glycated haemoglobin (HbA1c), fasting plasma glucose (FPG), fasting insulin (FINS), homeostatic model assessment of insulin resistance (HOMA-IR), interleukin-6 (IL-6), triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyltransferase (γ-GT), and quantitative detection of liver steatosis of study subjects were observed, the action of liver steatosis in subjects of groups A and C were significantly different from those of group B; however, there were no differences between groups A and C. The FINS, HOMA-IR, and IL-6 of subjects in group A was lower than those in groups B and C; however, there were no significant differences between the latter two groups. CONCLUSION For T2DM combined with NAFLD patients, the saxagliptin treatment could not only effectively control blood glucose but also attenuate insulin resistance and inflammatory injury of the liver to improve fatty liver further.


RESUMO OBJETIVO Investigar a eficácia clínica e os possíveis mecanismos da saxagliptina no tratamento do diabetes mellitus tipo 2 (DM2) associado à doença hepática gordurosa não alcoólica (DHGNA). MÉTODOS Um total de 95 DM2 combinados com pacientes com DHGNA foram aleatoriamente divididos em grupo A (grupo saxagliptina), grupo B (grupo glimepirida) e grupo C (glimepirida combinado com grupo fosfatidilcolina polienizada). RESULTADOS Após a intervenção tratamento por 24 w, índice de massa corporal (IMC), relação cintura-quadril (RCQ), hemoglobina glicada (HbA1c), glicemia de jejum (FPG), insulina de jejum (Fins), avaliação do modelo homeostático de insulina resistência (Homa-IR), interleucina-6 (IL-6), triglicérides (TG), colesterol total (CT), alanina aminotransferase (ALT), aspartato aminotransferase (AST), γ-glutamiltransferase (γ-GT) e detecção de esteatose hepática dos sujeitos do estudo foram observados. Ação de esteatose hepática de indivíduos nos grupos A e C foram significativamente diferentes do grupo B; no entanto, não houve diferenças entre os grupos A e C. Os grupos Fins, Homa-IR e IL-6 dos participantes do grupo A foram menores que os dos grupos B e C; no entanto, não houve diferenças significativas entre os dois últimos grupos. CONCLUSÃO Para o DM2 combinado com pacientes com DHGNA, o tratamento com saxagliptina pode não apenas controlar efetivamente a glicemia, mas também atenuar a resistência à insulina e a lesão inflamatória do fígado para melhorar ainda mais o fígado gorduroso.


Subject(s)
Humans , Male , Female , Phosphatidylcholines/administration & dosage , Sulfonylurea Compounds/administration & dosage , Adamantane/analogs & derivatives , Diabetes Mellitus, Type 2/drug therapy , Non-alcoholic Fatty Liver Disease/drug therapy , Hypoglycemic Agents/administration & dosage , Blood Glucose , Insulin Resistance , Adamantane/administration & dosage , Body Mass Index , Treatment Outcome , Diabetes Mellitus, Type 2/complications , Dipeptides/administration & dosage , Non-alcoholic Fatty Liver Disease/complications , Middle Aged
14.
Arch. endocrinol. metab. (Online) ; 62(6): 585-590, Dec. 2018. tab
Article in English | LILACS | ID: biblio-983810

ABSTRACT

ABSTRACT Objective: The aim was to characterize blood glucose fluctuations in patients with fulminant type 1 diabetes (FT1DM) at the stable stage using continuous blood glucose monitoring systems (CGMSs). Subjects and methods: Ten patients with FT1DM and 20 patients with classic type 1 diabetes mellitus (T1DM) (the control group) were monitored using CGMSs for 72 hours. Results: The CGMS data showed that the mean blood glucose (MBG), the standard deviation of the blood glucose (SDBG), the mean amplitude glycemic excursions (MAGE), the blood glucose areas and the percentages of blood glucose levels below 13.9 mmol/L were similar between the two groups. However, the percentage of blood glucose levels below 3.9 mmol/L was significantly higher in the FT1DM group compared to the T1DM group (p < 0.05). The minimum (Min) blood glucose level in the FT1DM group was significantly lower than that of the T1DM group (p < 0.05). Patients with FT1DM had severe dysfunction of the islet beta cells and alpha cells compared to patients with T1DM, as indicated by lower C-peptide values and higher glucagon/C-peptide values. Conclusion: In conclusion, patients with FT1DM at the stable stage were more prone to hypoglycemic episodes as recorded by CGMSs, and they had a greater association with severe dysfunction of both the beta and alpha islet cells compared to patients with T1DM.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Blood Glucose/analysis , Diabetes Mellitus, Type 1/blood , Reference Values , Blood Glucose/metabolism , C-Peptide/blood , Glucagon/blood , Blood Glucose Self-Monitoring/methods , Case-Control Studies , Retrospective Studies , Statistics, Nonparametric , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Insulin/blood
15.
Rev. bras. cir. cardiovasc ; 33(6): 618-625, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977465

ABSTRACT

Abstract Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.


Subject(s)
Humans , Postoperative Complications/prevention & control , Perioperative Care , Diabetes Mellitus/drug therapy , Cardiac Surgical Procedures , Hyperglycemia/drug therapy , Hypoglycemic Agents/administration & dosage , Clinical Protocols , Evidence-Based Medicine
16.
Int. j. morphol ; 36(3): 969-974, Sept. 2018. graf
Article in English | LILACS | ID: biblio-954216

ABSTRACT

Kidney injury secondary to diabetes is the most common cause of kidney failure. We sought to determine whether pretreatment with the insulin-sensitizing drug metformin prior to the induction of diabetes can protect the kidney against the development of diabetic nephropathy (DN) induced by a combination of a high-fat diet and streptozotocin. Rats were either injected with vehicle (control group) or with a single injection of streptozotocin (STZ) (50 mg/kg) two weeks after being fed on a high-fat diet (HFD) (model group) and continued on HFD until being sacrificed 10 weeks post diabetic induction. The protective group that also fed on a HFD for 12 weeks was put on metformin (200 mg/kg/day) two weeks before STZ injection and continued on metformin until the sacrifice day. Harvested kidney tissues were examined by light microscopy after staining with hematoxylin and eosin (H&E) and periodic acid Schiff (PAS). Blood samples were assayed for sugar, urea, creatinine, and biomarkers of inflammation. Compared to a normal tissue histology in the control group, there was a profound damage to the kidney in the model group as demonstrated by markedly dilated capsular space, increased mesangial matrix expansion, congested blood vessels, and many tubular epithelial cells showing small pyknotic nuclei and vacuolated cytoplasm, which were significantly but not completely protected by metformin. Our findings also show that metformin significantly inhibited the inflammatory biomarkers, tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) induced by diabetes and HFD as well as significantly inhibiting blood sugar, urea, and creatinine. However, the levels of TNF-α, CRP, glucose, and creatinine in the metformin-treated group was still significant to the control group. Thus, we demonstrated an efficient but not complete protection by metformin pretreatment against DN induced by a combination of HFD and streptozotocin in rats.


La lesión renal secundaria a la diabetes es la causa más común de insuficiencia renal. Intentamos determinar si el pre tratamiento con metformina, un fármaco sensibilizante a la insulina antes de la inducción de diabetes, puede proteger al riñón del desarrollo de la nefropatía diabética (DN) inducida por una combinación de una dieta alta en grasas y estreptozotocina. Las ratas fueron inyectadas con el medio (grupo de control) o con una inyección única de estreptozotocina (STZ) (50 mg / kg) dos semanas después de ser alimentadas con una dieta alta en grasas (HFD) (grupo modelo) y continuaron en HFD hasta ser sacrificadas 10 semanas después de la inducción diabética. El grupo protector que también se alimentó con un HFD durante 12 semanas recibió metformina (200 mg / kg / día) dos semanas antes de la inyección de STZ y continuó con metformina hasta el día en que fueron sacrificadas. Las muestras de riñón se examinaron mediante microscopía óptica después de la tinción con Hematoxilina y Eosina y ácido peryódico de Schiff (PAS). Las muestras de sangre se analizaron para determinar niveles de azúcar, urea, creatinina y biomarcadores de inflamación. Comparado con una histología tisular normal en el grupo control, hubo un daño profundo al riñón en el grupo modelo como lo demuestra el espacio capsular marcadamente dilatado, el aumento de la expansión de la matriz mesangial, los vasos sanguíneos congestionados y muchas células epiteliales tubulares que muestran pequeños núcleos picnóticos y citoplasma vacuolado, que fueron significativamente pero no completamente protegidos por la metformina. Nuestros hallazgos también muestran que la metformina inhibe significativamente los biomarcadores inflamatorios, el factor de necrosis tumoral alfa (TNF-a) y la proteína C reactiva (PCR) inducida por diabetes y DFH, e inhibe significativamente el azúcar en sangre, la urea y la creatinina. Sin embargo, los niveles de TNF-a, CRP, glucosa y creatinina en el grupo tratado con metformina todavía eran significativos para el grupo de control. Por lo tanto, demostramos una protección eficiente pero no completa mediante pretratamiento con metformina contra DN inducida por una combinación de HFD y estreptozotocina en ratas.


Subject(s)
Animals , Male , Rats , Diabetic Nephropathies/drug therapy , Hypoglycemic Agents/administration & dosage , Metformin/administration & dosage , Dietary Fats , Diabetes Mellitus, Experimental/complications , Diabetes Mellitus, Experimental/drug therapy , Disease Models, Animal
17.
Int. j. morphol ; 36(3): 984-990, Sept. 2018. graf
Article in English | LILACS | ID: biblio-954219

ABSTRACT

Potent heptatotoxic chemicals such as carbon tetrachloride and thioacetamide (TAA) are used to evaluate hepatoprotective agents. Here we sought to investigate the potential protective effect of the antidiabetic and antioxidant drug, metformin against liver injury induced by TAA. Model group rats received several injections of TAA (200 mg/kg) before being sacrificed after 10 weeks and the protective group started the treatment two weeks prior to TAA injections and continued receiving both agents, metformin and TAA until the end of the experiment, week 10. Harvested liver tissues were examined using light microscopy and liver homogenates were assayed for oxidative and anti-oxidative stress markers that are known to be modulated in liver injury. Profound damage in the hepatic tissue of the model group such as liver fibrosis and destruction of hepatic architectures were revealed, which were protected by metformin comparable to the control group. TAA augmented the oxidative stress biomarker, malondialdehyde (MDA) and ameliorated the antioxidant superoxide dismutase (SOD), which were significantly (p<0.05) protected by metformin treatment. These results indicate that metformin effectively protects against TAA-induced hepatotoxicity in a rat model.


Para evaluar los agentes hepatoprotectores se usan químicos heptatotóxicos potentes como el tetracloruro de carbono y la tioacetamida (TAA). En este estudio tratamos de investigar el efecto protector potencial de la droga antidiabética y antioxidante, la metformina contra la lesión hepática inducida por TAA. Las ratas del grupo modelo recibieron varias inyecciones de TAA (200 mg/kg) durante 10 semanas antes de ser sacrificadas, y el grupo protector comenzó el tratamiento dos semanas antes de las inyecciones TAA y continuó recibiendo ambos agentes, metformina y TAA, hasta el final del experimento. Los tejidos hepáticos se examinaron usando microscopía óptica y se analizaron los homogeneizados hepáticos en busca de marcadores de estrés oxidativo y antioxidante los que están modulados en la lesión hepática. Se observaron daños significativos en el tejido hepático del grupo modelo como la fibrosis hepática y destrucción de la arquitectura hepática, que estaban protegidas por la metformina comparable al grupo control. TAA aumentó el biomarcador de estrés oxidativo, malondialdehído (MDA) y mejoró la enzima antioxidante superóxido dismutasa (SOD), que fueron protegidas significativamente (p <0,05) por el tratamiento con metformina. Estos resultados indican que la metformina protege eficazmente contra la hepatotoxicidad inducida por TAA en un modelo de rata.


Subject(s)
Animals , Male , Rats , Thioacetamide/toxicity , Chemical and Drug Induced Liver Injury/prevention & control , Hypoglycemic Agents/administration & dosage , Metformin/administration & dosage , Oxidative Stress/drug effects , Disease Models, Animal , Liver/drug effects
18.
Medicina (B.Aires) ; 78(4): 286-289, ago. 2018. tab
Article in Spanish | LILACS | ID: biblio-954996

ABSTRACT

La polineuropatía desmielinizante inflamatoria crónica (PDIC) se presenta generalmente con síntomas motores, debilidad tanto en los músculos proximales como en los distales con reflejos globalmente disminuidos o ausentes. La neuritis insulínica es un trastorno caracterizado por dolor agudo de las extremidades, y daño de los nervios periféricos con afectación predominante de las fibras pequeñas, en los pacientes diabéticos sometidos a un rápido control glucémico. El dolor es raro en la PDIC clásica. Describimos el caso de una mujer de 54 años con diabetes mellitus (DB) tipo II, en tratamiento reciente con insulina, que consultó por un cuadro de debilidad e hiperalgesia de los cuatro miembros de dos meses de evolución. Al examen físico presentaba dolor de intensidad 10/10 y alodinia en los cuatro miembros, a niveles proximal y distal, con fuerza muscular reducida de los músculos proximales y arreflexia patelar y aquilea bilateral. Se realizó un estudio electrofisiológico, el cual mostró una polineuropatía sensitiva y motora desmielinizante. Se indicó tratamiento con inmunoglobina humana recombinante, con total remisión del cuadro. Estudios realizados posteriormente demostraron positividad débil de los anticuerpos GM1, GD1a, GD1b y anti-asialo GM1. Previo al alta hospitalaria se recibieron los resultados de VDRL sérica positiva, y FTA-Abs. VDRL en líquido cefalorraquídeo fue negativa por lo que se descartó neurosífilis, indicándose tratamiento con penicilina benzatínica.


Chronic inflammatory demyelinating polyneuropathy (CIDP) is a disorder characterized by motor symptoms such as weakness in both proximal and distal muscles with globally diminished or absent reflexes. Insulin neuritis is referred as an acute pain in the extremities, due to the damage of peripheral nerves affecting mainly small fibers, in diabetic patients treated with insulin who achieved rapid glycemic control. Pain is unusual in classic CIDP. We report the case of a 54-year-old female patient with type II diabetes mellitus, and a recent onset of insulin therapy, who presented at the emergency room with a 2-month history of weakness and hyperalgesia of extremities. Physical examination showed marked pain and proximal and distal allodynia in the 4 limbs, with reduced muscle strength of the proximal muscles and patellar and achillear areflexia. Electrophysiological study showed sensory and motor polyneuropathy with a demyelinating predominance. Treatment with recombinant human immunoglobin was started, and the patient presented a total remission of the condition. Complementary studies confirmed weak serum positivity of GM1, GD1a, GD1b and anti-asialo GM1. Prior to hospital discharge, results of positive serum VDRL and FTA-Abs were received. VDRL in cerebrospinal fluid was negative, so neurosyphilis was ruled out, and treatment with benzathine penicillin was indicated.


Subject(s)
Humans , Female , Middle Aged , Syphilis/complications , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/chemically induced , Diabetes Mellitus, Type 2/drug therapy , Hypoglycemic Agents/adverse effects , Insulin/adverse effects , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/diagnosis , Diabetes Mellitus, Type 2/complications , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage
19.
Medicina (B.Aires) ; 78(4): 225-233, ago. 2018. graf, tab
Article in Spanish | LILACS | ID: biblio-954988

ABSTRACT

La diabetes mellitus es una verdadera pandemia; la diabetes tipo 2 en particular, con su carácter progresivo, constituye un grave problema de salud. A pesar de los avances e innovaciones en el tratamiento, continúa generando una alta morbimortalidad, debido a que muchos pacientes no logran los objetivos de control metabólicos, entre otras causas por la inercia clínica, el temor a la hipoglucemia, el aumento de peso, la complejidad del tratamiento y la falta de adherencia al mismo. En el último tiempo, se ha evaluado con éxito los resultados clínicos del uso combinado de insulina basal y agonistas del receptor del péptido similar al glucagón tipo 1 (AR-GLP1). Se propone, por lo tanto, el uso combinado de una insulina basal (insulina degludec) con un AR-GLP1 (liraglutida), en un único dispositivo (IdegLira), como una alternativa terapéutica eficaz y segura para la intensificación del tratamiento de las personas con diabetes tipo 2. IdegLira ha demostrado mayores reducciones de HbA1c comparado con sus componentes individuales, con un bajo riesgo de hipoglucemia y pérdida de peso, tanto en pacientes naive de insulina como en aquellos previamente insulinizados. En esta revisión se describe la farmacología, el racional de la combinación y la evidencia clínica relevante de la seguridad y eficacia de IdegLira.


Diabetes mellitus is a true pandemic; type 2 diabetes in particular, with its progressive nature, constitutes a serious health problem. Despite advances and innovations in treatment, it continues to generate high morbidity and mortality.Many patients do not achieve their metabolic control objectives, due to clinical inertia, fear of hypoglycaemia, weight gain, the complexity of the treatment and the lack of adherence to it. Recently, the clinical results of the combined use of basal insulin and agonist receptor of the glucagon-like peptide type 1 (AR-GLP1) have been successfully evaluated. Therefore, the combined use of a basal insulin (insulin degludec) with an AR-GLP1 (liraglutide), in a single device (IdegLira), is proposed as an effective and safe therapeutic alternative for the treatment intensification in people with type 2 diabetes. IdegLira has shown greater reductions in HbA1c compared to its individual components, with a low risk of hypoglycaemia and weight loss, both in insulin naïve patients and in those previously insulinized. In this review we describe the pharmacology, the rational of the combination and the most relevant clinical evidence on IdegLira safety and efficacy.


Subject(s)
Humans , Insulin, Long-Acting/administration & dosage , Diabetes Mellitus, Type 2/drug therapy , Liraglutide/administration & dosage , Hypoglycemic Agents/administration & dosage , Clinical Trials as Topic , Drug Combinations , Drug Therapy, Combination
20.
Ciênc. Saúde Colet ; 23(8): 2565-2574, Aug. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-952735

ABSTRACT

Resumo O objetivo deste estudo foi avaliar o uso de medicamentos, a prevalência e os fatores associados à polifarmácia em pacientes com diabetes mellitus (DM) em Minas Gerais. Realizou-se um estudo transversal com descrição dos medicamentos em uso e análise da associação entre características sociodemográficas e clínicas com polifarmácia, por meio de regressão logística. Dos 2619 entrevistados, 56,5% estavam em polifarmácia. Medicamentos para DM, agentes no sistema renina-angiotensina e diuréticos foram os mais usados. Fatores como envelhecimento, presença de comorbidades e maior acesso aos serviços de saúde foram associados à polifarmácia. Observou-se elevada prevalência de polifarmácia, o que requer um cuidado adequado e melhor qualidade do uso de medicamentos para essa população.


Abstract The objective of this study was to evaluate the use of drugs and the factors associated with polypharmacy in patients with diabetes mellitus (DM) in Minas Gerais. Descriptive analysis of drugs in use and logistic regression to estimate the association between socio-demographic and clinical characteristics with polypharmacy were performed. Of the 2619 respondents, 56.5% were in polypharmacy. Drugs for DM, agent in renin-angiotensin system, and diuretics are the most frequently used. Factors such as age, comorbidities and increased access to health services were associated with polypharmacy. It was observed high prevalence of polypharmacy, which requires a suitable care and better quality of drug use in this population.


Subject(s)
Humans , Male , Female , Adult , Aged , Pharmaceutical Preparations/administration & dosage , Polypharmacy , Diabetes Mellitus/drug therapy , Health Services Accessibility , Renin-Angiotensin System/drug effects , Brazil , Logistic Models , Prevalence , Age Factors , Diuretics/administration & dosage , Drug Utilization , Hypoglycemic Agents/administration & dosage , Middle Aged
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