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1.
Medicina UPB ; 40(2): 80-83, 13 oct. 2021.
Article in Spanish | LILACS, COLNAL | ID: biblio-1342237

ABSTRACT

El suicidio es un problema de salud pública grave, vincula frecuentemente al consumo de medicamentos. La metformina es un fármaco antihiperglicemiante de fácil acceso y la sobredosis implica riesgos metabólicos, entre ellos, la acidosis láctica es el principal. Teniendo en cuenta la frecuencia de su consumo, es necesario que el personal de salud conozca los riesgos que implica la intoxicación y los signos y síntomas iniciales, pues del manejo adecuado dependerá un pronóstico favorable. El objetivo de este reporte es evidenciar los riesgos metabólicos renales-hemodinámicos, asociados a la toxicidad por metformina, además de resaltar la necesidad de considerar el uso temprano de la terapia de remplazo renal y de concientizar a los clínicos de que exponer a los pacientes a un medicamento, es también exponerlo a efectos adversos o a abuso con fines autolesivos.


Suicide is a serious public health problem that increases worldwide. In Medellín, its incidence is on the rise, and the most frequent mechanism is the ingestion of drugs. Metformin is an antihyperglycemic medication that is easily accessible and frequently used, because it is part of the first line of management of type 2 diabetes mellitus. One of the complications associated with its use is lactic acidosis, which can lead to serious toxicity. Therefore, it is necessary for the health personnel to be aware of the signs and symptoms that can initially appear in the case of intoxication, since a favorable prognosis depends on adequate management. The objective of this report is to present two clinical cases that evidence the wide spectrum of toxicity secondary to the use of metformin and to review the available evidence of the approach to this poisoning, emphasizing the importance of early use of renal replacement therapy.


O suicídio é um grave problema de saúde pública, frequentemente relacionado ao consu-mo de drogas. A metformina é um anti-hiperglicêmico de fácil acesso e a sobredosagem envolve riscos metabólicos, entre eles, a acidose láctica é o principal. Considerando a frequência de seu consumo, é necessário que o pessoal de saúde conheça os riscos das intoxicações e os sinais e sintomas iniciais, pois um prognóstico favorável dependerá de manejo adequado. O objetivo deste relatório é demonstrar os riscos metabólicos renais-hemodinâmicos associados à toxicidade da metformina, além de destacar a necessidade de considerar o uso precoce da terapia de substituição renal e alertar os médicos sobre o que expor os pacientes a um medicamento. a efeitos adversos ou abuso para fins autolesivos.


Subject(s)
Humans , Suicide , Metformin , Acidosis, Lactic , Diabetes Mellitus, Type 2 , Toxicity , Hypoglycemic Agents
2.
Femina ; 49(4): 251-256, 20210430.
Article in Portuguese | LILACS | ID: biblio-1224096

ABSTRACT

O diabetes mellitus gestacional (DMG) é uma complicação que atinge o metabolismo da gestante, resultando em intolerância à glicose e consequente hiperglicemia, originada pela insuficiência de insulina materna. Este estudo tem como objetivo identificar os tratamentos disponíveis e mais utilizados para o DMG. Trata-se de um uma revisão de literatura, feita a partir de 22 referências, acerca dos tratamentos para o DMG. As bases de dados escolhidas foram Google Acadêmico, UpToDate, SciELO e o acervo da Universidade do Planalto Catarinense. Estudos apontam a insulina humana ­ NPH e regular ­ como a principal escolha, quando comparada aos seus análogos, apesar de ainda existirem muitas controvérsias quanto ao início do tratamento, o esquema terapêutico e os ajustes das doses. Pesquisas têm demonstrado bons resultados sobre a eficácia e a segurança dos hipoglicemiantes orais ­ gliburida e metformina ­ no tratamento de gestantes diabéticas, mas é evidente a necessidade de mais estudos para confirmar a efetividade deles e garantir um bom desenvolvimento do concepto. Concluiu-se que o controle dietético e o exercício físico são a primeira opção de tratamento para o DMG. Todavia, caso a euglicemia não seja atingida, opta-se pelo tratamento medicamentoso por meio da insulinoterapia ou hipoglicemiantes orais, o que possibilita a redução da incidência dos efeitos adversos ao binômio materno-fetal.(AU)


Gestational diabetes mellitus (DMG) is a complication that affects the pregnant woman's metabolism, resulting in glucose intolerance and consequent hyperglycemia, caused by insufficient maternal insulin. This study aims to identify the available and most used treatments for DMG. This is a literature review, based on 22 references, about treatments for Gestational Diabetes; the databases chosen were Google Scholar, UpToDate, SciELO and the collection of the Universidade do Planalto Catarinense. Studies point to human insulin ­ NPH and regular ­ as the main choice when compared to its analogues, although there are still many controversies about the beginning of treatment, therapeutic scheme and dose adjustments. Researches have shown good results on the efficacy and safety of oral hypoglycemic agents ­ glyburide and metformin ­ in the treatment of diabetic pregnant women, but it is evident the need for further studies to confirm their effectiveness and to guarantee a good development of the fetus. It was concluded that dietary control and physical exercise are the first treatment option for DGM. However, if euglycemia is not achieved, drug treatment is chosen through insulin therapy or oral hypoglycemic agents, which makes it possible to reduce the incidence of adverse effects to the maternal-fetal binomial.(AU)


Subject(s)
Humans , Female , Pregnancy , Diabetes, Gestational/diet therapy , Diabetes, Gestational/drug therapy , Diabetes, Gestational/therapy , Diabetes Mellitus/drug therapy , Exercise , Databases, Bibliographic , Glyburide/adverse effects , Glyburide/therapeutic use , Hypoglycemic Agents/adverse effects , Hypoglycemic Agents/therapeutic use , Insulin/administration & dosage , Insulin/therapeutic use , Metformin/adverse effects , Metformin/therapeutic use
3.
Femina ; 49(3): 177-182, 20210331.
Article in Portuguese | LILACS | ID: biblio-1224087

ABSTRACT

O diabetes mellitus gestacional (DMG) é um distúrbio metabólico por déficit na produção e/ou ação insulínica. Tem relação direta com um constante estado catabólico associado com maior resistência à ação da insulina. Doença de difícil controle, implica risco materno-fetal elevado. O objetivo é estudar a eficácia das drogas antidiabéticas orais sobre o controle glicêmico no DMG e sua segurança quanto aos desfechos gestacionais e perinatais. Trata-se de revisão de literatura descritiva baseada em dados de artigos, livros-texto e guidelines emitidos nos últimos cinco anos. O antidiabético oral pode ser uma boa alternativa no controle do DMG em fase inicial da doença, na presença de distúrbio metabólico e como complemento da terapia com insulina. Entretanto, por causa de sua passagem placentária, há preocupações com seus efeitos fetais e perinatais. Estudos comparativos destacam a metformina no manejo do DMG, considerando principalmente a segurança materno-fetal.(AU)


Gestational diabetes mellitus (GDM) is a metabolic disorder caused by deficit in production and/or insulin action. It is directly related to a constant catabolic state associated with greater resistance to insulin action. Disease difficult to control, implies high maternal-fetal risk. To study the efficacy of oral antidiabetic drugs on glycemic control in GDM and its safety regarding gestational and perinatal outcomes. Descriptive literature review based on data from articles, textbooks and guidelines issued in the last five years. Oral antidiabetic can be a good alternative in the control of GDM in the initial phase of the disease, in the presence of metabolic disorder and as a complement to insulin therapy. However, there are concerns about its placental passage and perinatal effects. Comparative studies highlight metformin in the management of DMG considering mainly maternal-fetal safety.(AU)


Subject(s)
Humans , Female , Pregnancy , Pregnancy Complications/drug therapy , Diabetes, Gestational/drug therapy , Diabetes Mellitus/drug therapy , Hypoglycemic Agents/therapeutic use , Administration, Oral , Risk Factors , Glyburide/therapeutic use , Acarbose/therapeutic use , Metformin/therapeutic use
4.
Evid. actual. práct. ambul ; 24(2): e002072, 2021.
Article in Spanish | LILACS | ID: biblio-1254866

ABSTRACT

Los autores de este artículo abordan la evidencia disponible sobre la prevención de diabetes tipo 2 mediante la indicación de metformina en pacientes sin alteraciones de la glucemia, a partir de una consulta de la práctica ambulatoria. (AU)


The authors of this article discuss the available evidence on the prevention of type 2 diabetes through the prescription of metformin to patients without glycemic alterations, based on an outpatient practice consultation. (AU)


Subject(s)
Humans , Male , Adult , Primary Prevention , Diabetes Mellitus, Type 2/prevention & control , Metformin/therapeutic use , Blood Glucose/metabolism , Risk Factors , Disease Progression , Ambulatory Care , Life Style , Metformin/administration & dosage
5.
Clinics ; 76: e2669, 2021. graf
Article in English | LILACS | ID: biblio-1278915

ABSTRACT

OBJECTIVES: This study aimed to explore the efficacy of combination treatment with dendrobium mixture and metformin (Met) in diabetic cardiomyopathy (DCM) and its effects on NEAT1 and the Nrf2 signaling pathway. METHODS: H9c2 cells were maintained in medium supplemented with either low (5.5 mmol/L) or high (50 mmol/L) glucose. Male Sprague-Dawley rats were fed a high-glucose diet and administered a single, low dose of streptozotocin (35 mg/kg) via intraperitoneal injection to induce the development of DM. After induction of DM, the rats were treated with dendrobium mixture (10 g/kg) and Met (0.18 g/kg) daily for 4 weeks. Next, quantitative reverse transcription (qRT)-PCR and western blotting were performed to evaluate the expression levels of target genes and proteins. Flow cytometry was performed to assess apoptosis, and hematoxylin and eosin staining was performed to evaluate the morphological changes in rat cardiac tissue. RESULTS: In patients with diabetes mellitus (DM) and myocardial cells and heart tissues from rats with high glucose-induced DM, NEAT1 was downregulated, and the expression levels of Nrf2 were decreased (p<0.01, p<0.001). The combination of dendrobium mixture and Met upregulated the expression of NEAT1 which upregulated Nrf2 by targeting miR-23a-3p, resulting in reduced apoptosis and improved cardiac tissue morphology (p<0.01, p<0.001). CONCLUSION: Dendrobium mixture and Met upregulated the expression of NEAT1 in DCM, thereby inhibiting apoptosis of myocardial cells.


Subject(s)
Humans , Animals , Male , Rats , Dendrobium , MicroRNAs , Diabetes Mellitus , Diabetic Cardiomyopathies/genetics , Diabetic Cardiomyopathies/drug therapy , Metformin , Apoptosis , RNA, Long Noncoding/genetics
6.
Brasília; s.n; 16 jun. 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1100418

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 15 artigos. Foram encontrados 8 artigos e 15 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Technology Assessment, Biomedical , Immunoglobulins/therapeutic use , Dexamethasone/therapeutic use , Vaccines/pharmacology , Hydroxychloroquine/therapeutic use , Metformin/therapeutic use , Antibodies, Monoclonal/therapeutic use
7.
Brasília; s.n; 8 maio 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1097403

ABSTRACT

Essa é uma produção do Departamento de Ciência e Tecnologia (Decit) da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde (SCTIE) do Ministério da Saúde (Decit/SCTIE/MS), que tem como missão promover a ciência e tecnologia e o uso de evidências científicas para a tomada de decisão do SUS, tendo como principal atribuição o incentivo ao desenvolvimento de pesquisas em saúde no Brasil, de modo a direcionar os investimentos realizados em pesquisa pelo Governo Federal às necessidades de saúde pública. Informar sobre as principais evidências científicas descritas na literatura internacional sobre tratamento farmacológico para a COVID-19. Além de resumir cada estudo identificado, o informe apresenta também uma avaliação da qualidade metodológica e a quantidade de artigos publicados, de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, entre outros). Foram encontrados 14 artigos e 13 protocolos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Technology Assessment, Biomedical , Ivermectin/therapeutic use , Methylprednisolone/therapeutic use , Prednisolone/therapeutic use , Vaccines/therapeutic use , Chloroquine/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Drug Combinations , Oseltamivir/therapeutic use , Glucocorticoids/therapeutic use , Histamine Antagonists/therapeutic use , Hydroxychloroquine/therapeutic use , Metformin/therapeutic use
8.
Brasília; s.n; 26 maio 2020.
Non-conventional in Portuguese | LILACS, BRISA, PIE | ID: biblio-1097384

ABSTRACT

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referente ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 11 artigos.


Subject(s)
Humans , Pneumonia, Viral/drug therapy , Coronavirus Infections/drug therapy , Disease Progression , Betacoronavirus/drug effects , Adrenal Cortex Hormones/therapeutic use , Azithromycin/therapeutic use , Drug Combinations , Lopinavir/therapeutic use , Interferon alpha-2/ultrastructure , Hydroxychloroquine/therapeutic use , Immunosuppressive Agents/therapeutic use , Metformin/therapeutic use
10.
Rev. Bras. Saúde Mater. Infant. (Online) ; 20(1): 7-16, Jan.-Mar. 2020. tab, graf
Article in English | 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
11.
Article in English | WPRIM | ID: wpr-816619

ABSTRACT

BACKGROUND: This study was conducted to compare glycaemic control with insulin detemir administered according to two titration algorithms (3-0-3 and 2-4-6-8) after 20 weeks of treatment in subjects with type 2 diabetes mellitus inadequately controlled on metformin.METHODS: This was a 20-week, randomised, multicentre, open-labelled, treat-to-target trial. Forty-six patients were randomised in a 1:1 manner to either the 3-0-3 (G3, n=23) or 2-4-6-8 (G2, n=23) algorithm. The primary endpoint was change of haemoglobin A1c (HbA1c), and the secondary safety endpoint included hypoglycaemic events.RESULTS: After 20 weeks, HbA1c decreased similarly in the G3 and G2 groups, with a mean change of −0.9% from baseline. The mean change in fasting plasma glucose was numerically similar in both groups. The hypoglycaemia event rate per 100-patient-years of exposure (r) in the G2 group (r=1,427) was higher than that in the G3 group (r=807).CONCLUSION: Both treatment groups had numerically similar HbA1c reductions. A trend towards fewer hypoglycaemia episodes after dose stabilisation was seen with the simpler G3. Clinically, this may be an important observation, as a simpler titration algorithm may support self-management and maintenance of insulin therapy.


Subject(s)
Blood Glucose , Diabetes Mellitus, Type 2 , Fasting , Humans , Hyperglycemia , Insulin Detemir , Insulin , Metformin , Self Care
12.
Rev Assoc Med Bras (1992) ; 66(4): 458-465, 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136227

ABSTRACT

SUMMARY After metformin failure in treatment for diabetes type 2, there is no trivial option for adjuvant medication. The last two oral class medications, gliflozins and gliptins, have different mechanisms of action but have never been compared in long run studies. The aim of the present meta-analysis is to assess the overall long-term efficacy of these drugs after metformin failure. A systematic review and meta-analysis were performed, including all trials with a duration of over 2 years, comparing gliflozins or gliptins after metformin failure in type 2 diabetes. Data Sources: Pubmed (Medline), Embase, Lilacs, and the Cochrane Library from inception through July 2016 without language restrictions. The longest study period found in the literature was 4 years. We selected 1 article on empagliflozin, 1 on dapagliflozin, and 1 on saxagliptin with missing data. After one year of treatment, over 50% of the patients presented HbA1c > 7%. Efficacy rate after 4 years of empagliflozin (23%) was better than dapagliflozin (5%) and saxagliptin (7%); however, it presented statistically non-significant values for HbA1c (7.4 and 7.3% between gliflozins), and missing data for saxaglifozin. Nonetheless, empagliflozin performed better than glimepiride in the 4-year period (standardized mean difference SMD 0.4, confidence interval CI 95% 0.23 to 0.56). The failure of the secondary treatment using gliflozins occurs in less than one year of treatment (less than 50% of the patients presenting HbA1c > 7 %). Empagliflozin offered better glycemic control compared to sulfonylureas but was similar to dapagliflozin.


RESUMO Após a falha da metformina no tratamento do diabetes tipo 2, não existe uma opção trivial para a medicação adicional. Os dois últimos medicamentos de classe oral, gliflozinas e gliptinas, têm mecanismos de ação diferentes, mas nunca foram comparados em estudos de longo prazo. O objetivo da presente meta-análise é a avaliação da eficácia global em longo prazo desses medicamentos após a falha da metformina. Uma revisão sistemática e meta-análise foram realizadas, incluindo todos os ensaios com uma duração de mais de dois anos, comparando gliflozinas ou gliptinas após a insuficiência de metformina no diabetes tipo 2. Fontes de dados: PubMed (Medline), Embase, Lilacs e a Biblioteca Cochrane desde o início até julho de 2016, sem restrições de idioma. O período mais longo de estudo encontrado na literatura foi de quatro anos. Foi selecionado um artigo sobre empagliflozina, um artigo sobre dapagliflozina e um artigo sobre saxagliptina com dados faltantes. Após um ano de tratamento, mais de 50% dos pacientes apresentavam HbA1c >7%. A taxa de eficácia em quatro anos de empagliflozina (23%) foi melhor que dapagliflozina (5%) e saxagliptina (7%), porém com valores estatisticamente não significativos para HbA1c (7,4% e 7,3% entre gliflozinas) e dados ausentes para a saxaglifozina. No entanto, a empagliflozina teve um desempenho melhor do que a glimepirida no período de quatro anos (diferença média padronizada SMD 0,4, intervalo de confiança IC 95% 0,23 a 0,56). A falha do tratamento secundário com gliflozinas ocorre em menos de um ano de tratamento (menos de 50% dos pacientes com HbA1c >7%). A empagliflozina ofereceu melhor controle glicêmico em comparação com as sulfonilureias, mas semelhante à dapagliflozina.


Subject(s)
Humans , Diabetes Mellitus, Type 2/drug therapy , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Metformin , Benzhydryl Compounds , Network Meta-Analysis , Hypoglycemic Agents
13.
Mem. Inst. Oswaldo Cruz ; 115: e200272, 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1135255

ABSTRACT

BACKGROUND Metformin (MET) is a hypoglycemic drug used for the treatment of diabetes, despite interference in host immunity against microorganisms. Cutaneous infection caused by pathogens such as Leishmania braziliensis (Lb), the agent responsible for cutaneous leishmaniasis (CL) in Brazil, represents an interesting model in which to evaluate the effects associated with MET. OBJECTIVE To evaluate the modulatory effect of MET in Lb infection. MATERIAL AND METHODS Experimental study of Lb infection and MET treatment in BALB/c mice and Raw 264.7 macrophages. FINDINGS MET treatment interfered with lesion kinetics, increased parasite load and reduced macrophage proliferation. Low concentrations of MET in Lb culture allow for the maintenance of stationary parasite growth phase. Lb-infected cells treated with MET exhibited increased parasite load. While both MET and Lb infection alone promoted the production of intracellular reactive oxygen species (ROS), reduced levels of ROS were seen in MET-treated Lb-infected macrophages. MAIN CONCLUSION Experimental treatment with MET interfered with the kinetics of cutaneous ulceration, increased Lb parasite load, altered ROS production and modulated cellular proliferation. Our experimental results indicate that MET interfere with the evolution of CL.


Subject(s)
Animals , Mice , Leishmaniasis, Cutaneous/drug therapy , Leishmania/drug effects , Metformin/pharmacology , Leishmania braziliensis , Brazil , Mice, Inbred BALB C
14.
São Paulo; s.n; 2020. 28 p.
Monography in Portuguese | LILACS, SMS-SP, CACHOEIRINHA-Producao, SMS-SP | ID: biblio-1253002

ABSTRACT

Introdução: A Diabetes Mellitus engloba um conjunto de distúrbios metabólicos que levam a hiperglicemia e consequente deficiência insulínica. A incidência de Diabetes Mellitus Gestacional vem aumentando em conjunto com o aumento de casos de Diabetes Mellitus, constituindo um relevante problema de saúde atual. Dentre os principais fatores de risco para Diabetes Mellitus Gestacional aparecem a idade materna ≥ 35 anos, sobrepeso/ obesidade, história familiar de Diabetes Mellitus, entre outros, que levam muitas vezes à desfechos perinatais desfavoráveis como a macrossomia fetal e hipoglicemia neonatal. Como medida de tratamento inicial indica-se a mudança de estilo de vida, evoluindo para os tratamentos farmacológicos caso haja falha de tratamento inicial. Estes incluem a insulinoterapia (o padrão-ouro de tratamento) ou hipoglicemiantes orais, notadamente a metformina. Esta última desponta recentemente como uma alternativa de tratamento. Método: Trabalho elaborado através de revisão de literatura, com pesquisa realizada nas bases de dados Pubmed, LILACS e Cochrane. Foram selecionados artigos sobre diabetes gestacional contendo resultados sobre o uso de metformina e insulina, tanto no quesito de desfecho materno como perinatal, analisando os dados concordantes, discordantes ou indiferentes. Discussão: Alguns fatores têm sido comparados com relação ao uso das medicações disponíveis (metformina x insulina), a fim de constatar quais seriam as vantagens e desvantagens de cada método e seus desfechos perinatais. Os principais fatores estudados foram o ganho de peso materno, desenvolvimento de pré-eclampsia, prematuridade, necessidade de internação em UTI neonatal, Apgar de primeiro e quinto minuto, hipoglicemia neonatal, controle da glicemia materna, efeitos colaterais das medicações, peso de nascimento do recém nascido (RN) e seguimento do RN a longo prazo. Conclusão: Apesar de a insulinoterapia ainda ser padrão ouro no tratamento de diabetes mellitus gestacional, a metformina vem se mostrando método seguro e eficaz no controle da mesma, sem grandes diferenças nos resultados maternos e perinatais a curto e longo prazo.


Subject(s)
Humans , Female , Pregnancy , Diabetes, Gestational/therapy , Metformin
15.
Article in English | WPRIM | ID: wpr-881507

ABSTRACT

@#INTRODUCTION: Acne vulgaris has multifactorial causes. Prolonged systemic antibiotics are often necessary because relapse of lesions occurs upon its discontinuation. Currently, antimicrobial resistance is a growing concern. Androgen inhibitors like metformin may decrease need for antibiotics and maintain adequate control of the disease. OBJECTIVE: To determine the efficacy and safety of metformin versus placebo as an adjunct to lymecycline and adapalene+benzoyl peroxide gel in the treatment of moderate to severe acne vulgaris METHODS: Patients with moderate to severe acne vulgaris received either metformin or placebo tablets, together with lymecycline and adapalene+benzoyl peroxide gel. Lymecycline was taken for six weeks. The rest were given for 18 weeks. Evaluation was done biweekly using the mean reduction rates of non-inflammatory, inflammatory and total lesion count, modified global severity score, subjective self-assessment score, Dermatology life quality index (DLQI) score, and cutaneous and systemic adverse events. RESULTS: Forty patients were selected for the trial. Mean reduction rates of the non-inflammatory lesion counts of the two groups were comparable (p>0.05). Mean reduction rates of the inflammatory and total lesion count in the metformin group were higher than the placebo group (p<0.05). The mean modified global severity score of the metformin group was lower than the placebo group (p=0.034). Mean DLQI scores decreased in both groups (p<0.0001). Subjective self-assessment scores improved in both groups with comparable results. Cutaneous adverse events (erythema, pain, scaling, and dryness) were tolerable. Systemic adverse events (diarrhea, flatulence, headache, and epigastric pain) were self-limited CONCLUSION: Metformin is an effective and safe adjunct in the treatment of moderate to severe acne vulgaris.


Subject(s)
Lymecycline , Metformin , Acne Vulgaris
16.
Article in Chinese | WPRIM | ID: wpr-828876

ABSTRACT

OBJECTIVE@#To clarify the molecular signaling mechanism underlying the inhibitory effect of metformin on transforming growth factor-β1 (TGF-β1)-stimulated collagen I production in rat biliary fibroblasts.@*METHODS@#Primary biliary fibroblasts were isolated under aseptic condition from 50 Sprague-Dawley rats (half male and half female), and microscopic observation identified no obvious difference in the morphology or viability of the cells from rats with different sexes or body weight. The cells were treated with TGF-β1 (10 ng/mL), Smad3 siRNA+TGF-β1, CTGF siRNA+TGF-β1, metformin (10 mmol/L)+ TGF-β1, or Compound C (10 μmol/L)+metformin+TGF-β1. The expressions of CTGF and collagen I in the treated cells were determined using ELISA kit or Western blotting; the phorsphorylated and total Smad3 and AMPK expressions were detected using immunoblotting.@*RESULTS@#TGF-β1 time- and dose-dependently induced collagen I production in rat biliary fibroblasts. The activated AMPK by metformin dose-dependently inhibited TGF-β1-induced collagen I production. Pre-incubation of cells with the AMPK inhibitor Compound C restored the inhibitory effect of AMPK on TGF-β1-induced collagen I secretion ( < 0.01). Activation of AMPK by metformin significantly reduced TGF-β1-induced collagen I production by suppressing Smad3-driven CTGF expression ( < 0.01), and the application of Compound C reversed such changes in the fibroblasts ( < 0.01).@*CONCLUSIONS@#Metformin inhibits TGF-β1-stimulated collagen I production by activating AMPK and inhibiting Smad3- driven CTGF expression in rat biliary fibroblasts.


Subject(s)
Animals , Cells, Cultured , Collagen , Female , Fibroblasts , Male , Metformin , Rats , Rats, Sprague-Dawley , Signal Transduction , Smad3 Protein , Transforming Growth Factor beta1
17.
Article in English | WPRIM | ID: wpr-876092

ABSTRACT

@#Introduction. Vitamin B12 deficiency is more common among metformin-treated subjects although the prevalence is variable. Many factors have been associated with this. The aim of this study is to determine the prevalence of vitamin B12 deficiency and its associated factors among patients with type 2 diabetes mellitus (DM) who are on metformin. Methodology. A total of 205 patients who fit eligibility criteria were included in the study. A questionnaire was completed, and blood was drawn to study vitamin B12 levels. Vitamin B12 deficiency was defined as serum B12 level of ≤300 pg/ mL (221 pmol/L). Results. The prevalence of vitamin B12 deficiency among metformin-treated patients with type 2 DM patients was 28.3% (n=58). The median vitamin B12 level was 419 (±257) pg/mL. The non-Malay population was at a higher risk for metformin-associated vitamin B12 deficiency [adjusted odds ratio (OR) 3.86, 95% CI: 1.836 to 8.104, p<0.001]. Duration of metformin use of more than five years showed increased risk for metformin-associated vitamin B12 deficiency (adjusted OR 2.06, 95% CI: 1.003 to 4.227, p=0.049). Conclusion. Our study suggests that the prevalence of vitamin B12 deficiency among patients with type 2 diabetes mellitus on metformin in our population is substantial. This is more frequent among the non-Malay population and those who have been on metformin for more than five years.


Subject(s)
Vitamin B 12 , Metformin , Diabetes Mellitus, Type 2
18.
Article in English | WPRIM | ID: wpr-811152

ABSTRACT

The safety of metformin use for patients with type 2 diabetes mellitus (T2DM) and advanced kidney disease is controversial, and more recent guidelines have suggested that metformin be used cautiously in this group until more definitive evidence concerning its safety is available. The Korean Diabetes Association and the Korean Society of Nephrology have agreed on consensus statements concerning metformin use for patients with T2DM and renal dysfunction, particularly when these patients undergo imaging studies using iodinated contrast media (ICM). Metformin can be used safely when the estimated glomerular filtration rate (eGFR) is ≥45 mL/min/1.73 m². If the eGFR is between 30 and 44 mL/min/1.73 m², metformin treatment should not be started. If metformin is already in use, a daily dose of ≤1,000 mg is recommended. Metformin is contraindicated when the eGFR is <30 mL/min/1.73 m². Renal function should be evaluated prior to any ICM-related procedures. During procedures involving intravenous administration of ICM, metformin should be discontinued starting the day of the procedures and up to 48 hours post-procedures if the eGFR is <60 mL/min/1.73 m².


Subject(s)
Administration, Intravenous , Consensus , Contrast Media , Diabetes Mellitus , Diabetes Mellitus, Type 2 , Glomerular Filtration Rate , Humans , Kidney Diseases , Metformin , Nephrology , Renal Insufficiency , Renal Insufficiency, Chronic
19.
Article in English | WPRIM | ID: wpr-811147

ABSTRACT

BACKGROUND: There is limited information regarding the optimal third-line therapy for managing type 2 diabetes mellitus (T2DM) that is inadequately controlled using dual combination therapy. This study assessed the efficacy and safety of pioglitazone or glimepiride when added to metformin plus alogliptin treatment for T2DM.METHODS: This multicenter, randomized, active-controlled trial (ClinicalTrials.gov: NCT02426294) recruited 135 Korean patients with T2DM that was inadequately controlled using metformin plus alogliptin. The patients were then randomized to also receive pioglitazone (15 mg/day) or glimepiride (2 mg/day) for a 26-week period, with dose titration was permitted based on the investigator's judgement.RESULTS: Glycosylated hemoglobin levels exhibited similar significant decreases in both groups during the treatment period (pioglitazone: −0.81%, P<0.001; glimepiride: −1.05%, P<0.001). However, the pioglitazone-treated group exhibited significantly higher high density lipoprotein cholesterol levels (P<0.001) and significantly lower homeostatic model assessment of insulin resistance values (P<0.001). Relative to pioglitazone, adding glimepiride to metformin plus alogliptin markedly increased the risk of hypoglycemia (pioglitazone: 1/69 cases [1.45%], glimepiride: 14/66 cases [21.21%]; P<0.001).CONCLUSION: Among patients with T2DM inadequately controlled using metformin plus alogliptin, the addition of pioglitazone provided comparable glycemic control and various benefits (improvements in lipid profiles, insulin resistance, and hypoglycemia risk) relative to the addition of glimepiride.


Subject(s)
Cholesterol, HDL , Diabetes Mellitus, Type 2 , Dipeptidyl-Peptidase IV Inhibitors , Drug Therapy, Combination , Glycated Hemoglobin A , Humans , Hypoglycemia , Insulin Resistance , Metformin , Sulfonylurea Compounds , Thiazolidinediones , Treatment Failure
20.
Acta Physiologica Sinica ; (6): 532-538, 2020.
Article in Chinese | WPRIM | ID: wpr-827033

ABSTRACT

ATP is an important energy source for cells. Traditionally, intracellular ATP levels are believed to be relatively stable and will not rise consistently in the physiological conditions. However, new studies suggest that ATP levels may rise in multiple tissues under the condition of energy surplus contributing to the metabolic disorders in obesity. However, the molecular mechanism of ATP elevation remains unknown in obesity except the increase in energy supply. Based on our experimental results and the findings reported in the literature, we discuss the cellular and molecular mechanisms by which ATP levels are regulated in cells by multiple factors, including superoxide ions, mitochondrial flash, antioxidants, anti-apoptotic molecule Bcl-xL, AMP-activated protein kinase (AMPK) and metformin. Contribution of these factors to the alteration of ATP set-point will be discussed together with their impact on insulin resistance in type 2 diabetes mellitus. With a focus on the energy surplus in obesity, we explore the mechanism of insulin resistance induced by ATP elevation and provide an answer to the contradiction between the new experimental results and the traditional viewpoint of intracellular ATP. We propose that elevation of intracellular ATP may lead to metabolic disorder in obesity through activation of a feedback mechanism that inhibits mitochondrial function.


Subject(s)
AMP-Activated Protein Kinases , Adenosine Triphosphate , Diabetes Mellitus, Type 2 , Energy Metabolism , Humans , Metformin , Obesity
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