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Introducción: Las bondades que ofrece el uso de los inhibidores del cotransportador sodio-glucosa tipo 2 en el tratamiento de la diabetes mellitus, se reportan preocupantes eventos y reacciones adversas por el empleo de este grupo de medicamentos. De ahí, la necesidad de su conocimiento por parte de los facultativos. Objetivo: Mencionar las reacciones adversas a medicamentos más frecuentes de los inhibidores del cotransportador sodio-glucosa tipo 2 en personas con diabetes mellitus. y describir aquellas de mayor interés clínico por su gravedad. Métodos: La información se obtuvo en el trimestre octubre-diciembre de 2020. Se evaluaron diferentes artículos de revisión, de investigación y páginas Web, en general tenían menos de 10 años de publicados, en idioma español, portugués o inglés. Se utilizó como motores de búsqueda de información científica a Google Académico, Pubmed y SciElo. Fueron utilizadas como palabras claves: inhibidores del cotransportador sodio-glucosa tipo 2; tratamiento; reacciones adversas; y diabetes mellitus. Fueron excluidos los artículos que no reunían las condiciones señaladas. Esto permitió el estudio de 88 artículos, de los cuales 50 fueron referenciados. Conclusiones: Los inhibidores del cotransportador sodio-glucosa tipo 2, pueden producir variadas reacciones adversas -descritas en el texto-, que de manera potencial pueden aumentar la morbilidad y mortalidad. Su uso ofrece la posibilidad de reacciones adversas graves de interés clínico, entre las que se describen: cetoacidosis diabética euglucémica, insuficiencia renal aguda, riesgo de amputaciones de los pies y fascitis necrosante del perineo.
Introduction: The benefits offered by the use of sodium-glucose cotransporter type 2 inhibitors in the treatment of diabetes mellitus, worrisome adverse events and reactions are reported for the use of this group of drugs. Hence, the need for physicians to be aware of them. Objective: To describe the most frequent adverse drug reactions of sodium-glucose cotransporter type 2 inhibitors in people with diabetes mellitus and those of greatest clinical interest due to their severity. Methods: The information was obtained in the October-December 2020 quarter. Different review articles, research articles and Web pages were evaluated, generally less than 10 years old, in Spanish, Portuguese or English. Google Scholar, Pubmed and SciElo were used as search engines for scientific information. The following keywords were used: sodium-glucose cotransporter type 2 inhibitors; treatment; adverse reactions; and diabetes mellitus. Articles that did not meet the indicated conditions were excluded. This allowed the study of 88 articles, of which 50 were referenced. Conclusions: Type 2 sodium-glucose cotransporter inhibitors can produce various adverse reactions -described in the text-, which can potentially increase morbidity and mortality. Their use offers the possibility of serious adverse reactions of clinical interest, among which the following are described: euglycemic diabetic ketoacidosis, acute renal failure, risk of foot amputations and necrotizing fasciitis of the perineum.
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RESUMEN Introducción: Los pacientes con diabetes mellitus tipo 2 suelen ser poco adherentes en sus tratamientos por diversas razones y factores. Objetivos: Exponer las cifras de prevalencia de la no adherencia terapéutica en pacientes con diabetes mellitus tipo 2, los factores asociados y los instrumentos que han sido utilizados, con mayor frecuencia, en la evaluación de este constructo. Métodos: Se realizó una revisión sistemática, cuyo criterio de búsqueda fue la adherencia terapéutica en pacientes con diabetes mellitus tipo 2. Se consultaron las bases de datos electrónicas: EBSCO, PubMed, SciELO, Dialnet, ScienceDirect y el Google Académico. Se estableció como criterios de inclusión: Artículos publicados en revistas científicas revisadas por pares, desde el 2016 en lo adelante y en los idiomas español, inglés y portugués y, como criterios de exclusión, los estudios de intervención y aquellos que evaluaban, conjuntamente, la adherencia terapéutica en pacientes con diabetes mellitus y otras enfermedades crónicas. Conclusiones: En pacientes con diabetes mellitus tipo 2, la adherencia al tratamiento farmacológico resulta más adecuada que al tratamiento no farmacólogico. Su evaluación se realiza, fundamentalmente, a través de pruebas validadas, donde la más empleada fue la prueba de Morisky-Green. En los estudios citados la no adherencia terapéutica se asocia a factores sociodemográficos, socioeconómicos, relacionados con las complejidades del tratamiento, con la enfermedad, con dificultades en la relación médico-paciente y con la presencia de estados emocionales negativos. Los factores subjetivos y comportamentales como: La autoeficacia, el autocontrol y la autorregulación, han sido poco estudiados.
ABSTRACT Introduction: patients with type 2 diabetes mellitus tend to be poorly adherent to their treatments due to various reasons and factors. Objectives: to present prevalence figures of medication non-adherence in patients with type 2 diabetes mellitus, its associated factors and the most frequently used instruments in the evaluation of this construct. Methods: a systematic review, whose search criterion was medication adherence in patients with type 2 diabetes mellitus, was carried out. Electronic databases such as EBSCO, PubMed, SciELO, Dialnet, ScienceDirect and Google Scholar were consulted. Articles published in peer-reviewed scientific journals, in Spanish, English and Portuguese languages from 2016 onwards were the established inclusion criteria, as well as intervention studies and those that evaluated the medication adherence in patients with diabetes mellitus together with other chronic diseases were the exclusion criteria. Conclusions: adherence to pharmacological treatment in patients with type 2 diabetes mellitus is more adequate than non-pharmacological ones. Its evaluation is carried out, fundamentally, through validated tests, where Morisky-Green was the most used test. In the cited studies, medication non-adherence is associated with sociodemographic and socioeconomic factors, related to the complexities of the treatment, with the disease, with difficulties in the doctor-patient relationship and with the presence of negative emotional states. Subjective and behavioral factors such as self-efficacy, self-control and self-regulation have been little studied.
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Diabète de type 2 , Adhésion et observance thérapeutiquesRésumé
Introduction: Microalbuminuria has relationship on thedevelopment of coronary heart disease and it may identify asa new risk factor of this disease. The MA happens more oftenin diabetic patients with AMI but it has been reported evenin non –diabetic patients with AMI. The aim of the presentstudy was to assess the prevalence of microalbuminuria innon diabetic and non hypertensive patients suffering fromAMI. To evaluate the relationship between MA and AMI innon- diabetic and non hypertensive patients admitted in ICCUcardiology department at Rajshree Medical Research InstituteBareilly (UP).Matereial and methods: The study was carried out in thedepartment of Biochemistry and ICCU in RMRI, Bareilly(UP) to establish the correlation between MA with 50non diabetic, non hypertensive patients of AMI and in50 healthy age matched controls. MA was determined byimmunoturbidimetric method and plasma glucose weremeasured by enzymatic method.Result: There was a significant increase in the level of MA inpatients with AMI who were non diabetic, non hypertensive ascompare to those in the healthy control.Conclusion: MA may have an association with AMI inabsence of traditional risk factors like diabetes and HTN. SoMA can be used as an adjunct biochemical parameter in nondiabetic, non hypertensive AMI patients.
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Background: Non communicable diseases like obesity and diabetes are increasing worldwide, healthcare physicians are also not immune to this morbidity. The objective of this study is to find the prevalence of obesity and diabetes among healthcare physicians.Methods: The study was done at a tertiary care hospital in Pondicherry. All adult health care physicians of both sexes working in the hospital and giving informed consent to participate in the study were included. Pregnant physicians and those who are not willing to give written consent for participation in the study were excluded from the study. The study was done as a cross sectional study using a pretested standardized questionnaire. Age, sex, demographic data, height, weight, diet habits, family history of diabetes, exercise, medication in all the health care physicians were recorded and studied.Results: Of the total one hundred health care physicians, there were 50 male and 50 female physicians. Among the female physicians, there were 17 of age 41 to 50 years. There were 27 male and 34 female physicians with body mass index of 25 to 29.9. Six males and four females had diabetes mellitus. Six physicians were doing regular exercise. Four physicians were taking both oral anti hyperglycemic drugs and insulin.Conclusions: Doctors are aware and educated part of the society but there is high prevalence of obesity and diabetes mellitus among healthcare physicians. Doctor have to be motivated to take care of their health and to prevent lifestyle disease complication. Further regular screening for diabetes and obesity has to be done for doctors.
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Background: The study aimed to assess the prevalence of Hypertension (HTN), Diabetes mellitus(DM) and other diseases along with comorbid conditions, disease complications and also to assess medication adherence in a tertiary hospital in Karimnagar, Telangana, India.Methods: A Cross sectional study is performed by analysing a total of 500 patient抯 individual case safety reports (ICSR). Prevalence of Hypertension and Diabetes along with most prescribed drugs are analysed. Medication adherence is analysed by using Morisky Medication adherence questionnaire scale (MMAS-4).Results: Patients with past history of DM, HTN and other diseases which was found to be 245 (49%) patients. Patients with highest disease prevalence were found to be with HTN (56.73%), DM (31.83%) followed by other diseases like asthma (8.57%), Cerebrovascular accident (4.89%) etc., Total of 66 Patients were ruled out with comorbid diseases. Patients with HTN+DM (47) were found to be highest followed by DM+HTN+CVA (4). MMAS-4 revealed 208 patients were using medication out of 245 patients with previous history. According to MMAS-4 most of the patients were with medium adherence (76). Prevalent drug used for HTN include Amlodipine and for DM Telmisartan+Hydrochlorthiazide.Conclusions: The study revealed that almost half of the admitted patients were with HTN and DM. The patients were counselled properly to adhere strictly to the prescription. Medication adherence to HTN and DM was found to be good in this study. Since the disease complications were also ruled out, the health care professionals are recommended to spread awareness on DM and HTN and disease management in order to control disease and improve health outcomes.
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Diabetic cognitive dysfunction,a glucose metabolic disorder,is caused by metabolic,neurochemistrical,morphological,electrical physiological and behavioral changes featuring the disability of reasoning and learning,memory loss,inattention and hypophrenia.In recent years,more attention has been attached to the field of medicine.In this review,a progress of cognitive disorder was systematically explored over the pathogenesis and treatment of both TCM and western medicine,and investigated multi-targets and multiple methods of Chinese herbal researches at multiple stages for expanding the range of clinical application of TCM,enriching and developing the theory of TCM compatibility,and promoting the advantages of TCM syndrome differentiation.
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A doença renal crônica (DRC) compromete não só o sistema urinário, mas toda a homeostase do organismo. A progressão da perda da função renal pode provocar complicações como acidose metabólica e alterações cardiovasculares. Em sua fase mais avançada (falência funcional renal), os rins não conseguem manter a homeostase do meio interno, sendo necessária terapia de substituição renal - hemodiálise. Dentre as causas mais comuns de DRC, temos o diabetes melitus que, juntamente com a história familiar, determinam um quadro de risco elevado para o desenvolvimento da alteração renal. Esse estudo teve como objetivo comparar os exames laboratoriais de pacientes em hemodiálise diabéticos e os não diabéticos de uma clínica particular de Maringá-PR. Analisamos os exames de rotina de 55 pacientes, 25 diabéticos e 30 não diabéticos, que se submeteram a hemodiálise regular. Os resultados foram subdivididos em: P1= inicial, P2= 4, P3= 8 e P4= 12 meses. Os dados foram estatisticamente analisados pelo teste. Concluindo, a comparação dos exames de rotina dos pacientes em hemodiálise diabéticos e não diabéticos mostrou que os níveis plasmáticos da creatinina, ureia pré e pós-hemodiálise, proteína, albumina, potássio, cálcio e hematócrito dos pacientes diabéticos não foram estatisticamente diferente dos não diabéticos. No entanto, houve aumento significativo nos leucócitos dos pacientes diabéticos em hemodiálise (diabéticos: P1= 7743 ± 2698; P2= 7417 ±2066; P3= 8115 ± 2957; P4= 7774 ±2160 e não diabéticos: P1= 6052 ± 1984; P2= 6006 ± 857; P3= 6331 ± 1845; P4= 5551 ± 2011).
Chronic renal disease (CRD) affects not only the urinary system, but also the body homeostasis. The progression of renal function loss may lead to complications such as metabolic acidosis and cardiovascular alterations. In the most complicated and advanced phase, kidneys do not keep the homeostasis of internal body, and kidney replacement therapy ? hemodialysis ? is necessary. Among the causative agents of CRD, diabetes mellitus, in conjunction with familiar history, determine an elevated risk for the development of renal alteration. This study aimed to compare the laboratorial tests of diabetic and non-diabetic hemodialysis patients from a private clinic in Maringá - PR. Routine tests from 55 patients, 25 diabetic and 30 non-diabetics, submitted to regular hemodialysis were analyzed. Data were divided as: P1= initial, P2= 4, P3= 8 and P4= 12 months. Data showed that plasma creatinine, urea pre- and post- hemodialysis, protein, albumin, potassium, calcium and hematocrit of diabetic patients were not statistically different from the non-diabetic. However, leukocytes were significantly increased in diabetic patients submitted to hemodialysis (diabetic: P1= 7743 ± 2698; P2= 7417 ±2066; P3= 8115 ± 2957; P4= 7774 ±2160 and non-diabetic: P1= 6052 ± 1984; P2= 6006 ± 857; P3= 6331 ± 1845; P4= 5551 ± 2011).