Metformina: uso clínico y actualización / Metformin: clinical use and update

La metformina (biguanida), grupo de medicamentos que proceden de la guanidina, se ha utilizado desde época medieval para tratamiento de la diabetes. Esta revisión bibliográfica narrativa tiene el propósito de contribuir a mejorar su uso clínico. Se realizó búsqueda de artículos originales, revisiones sistemáticas y artículos de revisión en internet, período 2012-2018, o anterior si fuera relevante. La metformina actúa como un hipoglucemiante, reduce la producción hepática de glucosa inhibiendo la gluconeogénesis y la glucogenólisis, aumenta captación de glucosa a nivel muscular y disminuye absorción de glucosa a nivel gastrointestinal. Una vez intracelular, aumenta la glucólisis anaerobia, uno de sus principales efectos adversos. La metformina es un fármaco que genera incremento de sensibilidad a insulina, mayor control de la glucemia, mejoría del perfil lipídico y de la función vascular, es de bajo costo y es en la actualidad la primera opción en el tratamiento de la diabetes mellitus tipo 2...(AU)

Appetite disorders in cancer patients: Impact on nutritional status and quality of life.

Cancer patients are at high risk of malnutrition due to several symptoms such as lack of appetite. The aim of this study was to determine the prevalence of different appetite disorders in cancer patients and their influence on dietary intake, nutritional status, and quality of life. We conducted a cross-sectional study of cancer patients at risk of malnutrition. Nutritional status was studied using Subjective Global Assessment, anthropometry, and grip strength. Dietary intake was evaluated with a 24-h recall, and patients were questioned about the presence of changes in appetite (none, anorexia, early satiety, or both). Quality of life was measured using EORTC-QLQ-C30. Multivariate analysis was performed using linear regression. 128 patients were evaluated. 61.7% experienced changes in appetite: 31% anorexia, 13.3% early satiety, and 17.2% both. Appetite disorders were more common in women and with the presence of cachexia. The combination of anorexia and satiety resulted in a lower weight and BMI. However, there were no significant effects on energy or macronutrient intake among different appetite alterations. Patients with a combination of anorexia and early satiety had worse overall health perception, role function, and fatigue. Appetite disorders are highly prevalent among cancer patients at risk of malnutrition. They have a significant impact on nutritional status and quality of life, especially when anorexia and early satiety are combined.