Adjuvantes no tratamento da hiperglicemia do diabetes melito tipo 1

Adjuvantes no tratamento da hiperglicemia do diabetes melito tipo 1

Alternative title Adjunctive therapies to glycaemic control of type 1 diabetes mellitus
Author Gabbay, Monica Andrade Lima Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract Since Diabetes Control and Complications Trial (DCCT), intensive therapy has been directed at achieving glucose and glycosylated hemoglobin (HbA1c) values as close to normal as possible regarding safety issues. However, hyperglycemia (especially postprandial hyperglycemia) and hypoglicemia continue to be problematic in the management of type 1 diabetes. The objective of associating other drugs to insulin therapy is to achieve better metabolic control lowering postprandial blood glucose levels. Adjunctive therapies can be divided in four categories based on their mechanism of action: enhancement of insulin action (e.g. the biguanides and thiazolidinediones), alteration of gastrointestinal nutrient delivery (e.g. acarbose and amylin) and other targets of action (e.g. pirenzepine, insulin-like growth factor I and glucagon-like peptide-1). Many of these agents have been found to be effective in short-term studies with decreases in HbA1c of 0.5-1%, lowering postprandial blood glucose levels and decreasing daily insulin doses.

Desde o Diabetes Control and Complications Trial (DCCT), a terapia insulínica intensiva tem sido direcionada para alcançar valores de glicemia e hemoglobina glicada (HbA1c) tão próximos do normal quanto a segurança permita. Entretanto, a hiperglicemia (especialmente a hiperglicemia pós-prandial) e a hipoglicemia continuam a ser um problema no manejo do diabetes tipo 1. O objetivo de associar outras drogas à terapia insulínica é diminuir a glicemia pós-prandial. A terapia adjunta pode ser dividida em três grupos, conforme seu mecanismo de ação: 1. Aumento da ação da insulina (metformina e tiazolidinedionas); 2. Alteração da liberação de nutrientes no trato gastrintestinal (acarbose e amilina); 3. Outros modos de ação [pirenzepina, fator de crescimento insulina-símile (IGF-1) e peptídeo semelhante ao glucagon 1 (GLP-1). Muitos desses agentes mostraram, em estudos de curto prazo, diminuição de 0,5% a 1% na HbA1c, diminuir a hiperglicemia pós-prandial e as doses diárias de insulina.
Keywords Type 1 diabetes
Hyperglycemia
Treatment
Adjunctive agents
Diabetes tipo 1
Hiperglicemia
Terapêutica
Adjuvantes
Language Portuguese
Date 2008-03-01
Published in Arquivos Brasileiros de Endocrinologia & Metabologia. Sociedade Brasileira de Endocrinologia e Metabologia, v. 52, n. 2, p. 279-287, 2008.
ISSN 0004-2730 (Sherpa/Romeo, impact factor)
Publisher Sociedade Brasileira de Endocrinologia e Metabologia
Extent 279-287
Origin http://dx.doi.org/10.1590/S0004-27302008000200015
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000256344700015
SciELO ID S0004-27302008000200015 (statistics in SciELO)
URI http://repositorio.unifesp.br/handle/11600/4273

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