Efectos en vida real de la adición de semaglutida subcutánea semanal al tratamiento con insulina en diabetes mellitus tipo 2 / Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus

Objetivos: Determinar en la vida real los beneficios antropométricos y analíticos de la adición de semaglutida por vía subcutánea al tratamiento previo con insulina en pacientes con diabetes tipo 2.Métodos: Estudio descriptivo, retrospectivo y abierto en el que se describen características clínicas y antropométricas de 117 pacientes diagnosticados de diabetes tipo 2 seguidos en las consultas externas de Endocrinología y Nutrición del Hospital Universitario Central de Asturias a lo largo de 53 semanas tras el inicio de tratamiento con semaglutida subcutánea (octubre-diciembre 2019). Todos los pacientes estaban en tratamiento previo con insulina, con o sin antidiabéticos orales.Resultados: De los 117 pacientes iniciales, 17 no completaron el estudio debido a efectos adversos (náuseas, vómitos), decisión clínica y pérdida de seguimiento.A los 12 meses (semana 53) del inicio de la semaglutida se obtuvo un descenso de HbA1c de 0,74% (IC 95% 0,59-1,14, p<0,05), así como de 3,61kg de peso (IC 95% 2,30-4,92, p<0,05), y de 15,88 UI de insulina total (IC 95% 10,98-20,74, p<0,05) respecto a las cifras basales. En pacientes sin análogo del receptor de GLP-1 (arGLP-1) previo, el efecto en la disminución de HbA1c, el peso y la dosis total de insulina fue estadísticamente significativo; sin embargo, los pacientes pretratados con arGLP-1 solo tuvieron mejoría en la reducción de peso. No se observaron eventos adversos graves.Conclusiones: La adición de semaglutida subcutánea al tratamiento previo con insulina con o sin antidiabéticos orales induce una disminución de HbA1c, peso y dosis de insulina de forma segura. Este efecto es mayor en pacientes naïve para tratamiento con arGLP-1. (AU)

Objectives: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes.Methods: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics.Results: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up.Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p<0.05) as well as 3.61kg of weight loss (95% CI 2.30-4.92, p<0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p<0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed.Conclusions: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients. (AU)

Metaanálisis para evaluar el riesgo de infecciones respiratorias y síndrome de distrés respiratorio del adulto con los agonistas del receptor del péptido similar al glucagón tipo 1 en los ensayos de seguridad cardiovascular: consecuencias útiles para la pandemia de COVID-19 / Meta-analysis evaluating the risk of respiratory tract infections and acute respiratory distress syndrome with glucagon-like peptide-1 receptor agonists in cardiovascular outcome trials: Useful implications for the COVID-19 pandemic

Los pacientes con diabetes mellitus tipo 2 (DMT2) presentan un mayor riesgo de experimentar una enfermedad grave por coronavirus 2019 (COVID-19) con un incremento de la mortalidad relacionada. Los agonistas del receptor del péptido similar al glucagón tipo 1 (AR-GLP-1) ejercen efectos cardiovasculares y renales beneficiosos en los pacientes con DMT2 de alto riesgo cardiovascular. Sus propiedades antiinflamatorias podrían resultar beneficiosas en estos pacientes. El presente estudio es un metaanálisis sobre el riesgo de infección respiratoria y distrés respiratorio del adulto causado por AR-GLP-1 utilizando como fuente los ensayos clínicos de seguridad cardiovascular publicados en la bibliografía. Hay que destacar que los AR-GLP-1 no parecen aumentar el riesgo de infección respiratoria, neumonía ni síndrome de distrés respiratorio del adulto en los pacientes con DMT2 y alto riesgo cardiovascular (AU)

Patients with type 2 diabetes mellitus (T2DM) are at increased risk for severe coronavirus disease 2019 (COVID-19) and related mortality. Glucagon-like peptide-1 receptor agonists (GLP-1-RAs) have significant cardiovascular and renal benefits for patients with T2DM and related comorbidities. Their anti-inflammatory properties could be beneficial in these patients. This work provides less-biased estimates regarding the risk for respiratory tract infections and acute respiratory distress syndrome by performing the first significant meta-analysis of cardiovascular outcome trials in the literature. Notably, GLP-1-RAs do not seem to increase the risk for respiratory tract infection, pneumonia, or acute respiratory distress syndrome in patients with T2DM and cardiovascular comorbidities (AU)

¿Qué pueden aportar los agonistas del receptor de GLP1 en el tratamiento de los pacientes con enfermedad hepática grasa no alcohólica? / No disponible

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The efficacy of glucagon-like peptide 1 receptor agonists in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: non-alcoholic fatty liver disease (NAFLD) is considered as the hepatic manifestation of metabolic syndrome and is highly prevalent all over the world. New drugs are urgently needed for the treatment of NAFLD. The aim of this meta-analysis was to assess the efficacy of glucagon-like peptide 1 receptor agonists (GLP-1RAs) in patients with NAFLD. METHOD: English language publications in the PubMed, Cochrane Library, Embase and Web of Science databases were searched from inception to October 2019. All randomized controlled trials (RCTs) of GLP-1RAs treatment for NAFLD were considered. Standardized mean difference (SMD) with 95 % confidence intervals (CIs) were pooled using the fixed-effects or random-effects model. RESULTS: six RCTs, involving 406 patients, were included in the analysis. A significant improvement was found in liver fat fraction (LFF) (SMD = -0.33, 95 % CI, -0.64 to -0.03, p = 0.034), body mass index (BMI) (SMD: -0.89, 95 % CI: -1.60 to -0.19, p = 0.012) and adiponectin (SMD: 0.66, 95 % CI: 0.37 to 0.95, p = 0.000) with GLP-1RAs treatment. There were no significant differences in serum alanine aminotransferase (ALT) (SMD: -0.52, 95 % CI: -1.04 to 0.01, p = 0.054) and aspartate transaminase (AST) (SMD: -0.20, 95 % CI: -0.54 to 0.15, p = 0.134) reduction between the GLP-1RAs and control groups. In the subgroup analysis, exenatide was associated with an improvement in serum ALT (SMD = -1.25, 95 % CI: -1.68 to -0.82, p = 0.000) and AST (SMD = -0.62, 95 % CI: -1.16 to -0.08, p = 0.024). Liraglutide was associated with a reduction in BMI (SMD = -0.44, 95 % CI: -0.77 to -0.11, p = 0.010) and an increase in adiponectin (SMD = -0.33, 95 % CI, -0.64 to -0.03, p = 0.034). CONCLUSION: our study suggested that GLP-1RAs may improve LFF, BMI and adiponectin in patients with NAFLD. Furthermore, the potential efficacy to treat NAFLD was also shown. More high-quality RCTs are needed to validate our findings

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Combination therapy with once-weekly glucagon like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes: a case series

BACKGROUND: National treatment guidelines recommend glucagon-like peptide receptor agonists (GLP-1 RAs) as add-on therapy to oral agents. However, GLP-1 RAs in combination with dipeptidyl peptidase-4 (DPP-4) inhibitors is not recommended due to a lack of evidence. OBJECTIVE: This case series aims to describe the efficacy and safety of once-weekly GLP-1 RAs administered concomitantly with DPP-4 inhibitors in patients with type 2 diabetes. METHODS: A retrospective chart review of electronic medical records at a free health clinic was conducted between July 2014 and September 2016. Patients 18 years and older with type 2 diabetes were included if they received concomitant DPP-4 inhibitor and once-weekly GLP-1 RA therapy with at least one glycated hemoglobin A1c (HbA1c) measurement within three to six months of starting the combination. The primary and secondary outcomes included change in HbA1c and weight, and patient reported adverse events. RESULTS: Out of forty-three patients that received combination DPP-4 inhibitor plus GLP-1 RA therapy, only eighteen received once-weekly GLP-1 RA. At 3 months, the median (IQR) HbA1c and weight change was -0.8% (-4.3 to 2%) and -0.4kg (-4.2 to 5.8 kg) respectively. No patients reached an HbA1c below 7% and only three patients (17%) reached a HbA1c less than 8%. Patient reported adverse effects included gastrointestinal disturbances (28%), hypoglycemic symptoms (17%), and injection site reactions (0.6%). CONCLUSIONS: Concomitant use of once-weekly GLP-1 RAs and DPP-4 inhibitors provides only modest improvement in glycemic control with minimal weight loss benefits, which is similar to monotherapy with either agent. The combination is unlikely to provide synergistic effects and is not cost effective. These data support the current recommendations against use of combined incretin therapy

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Nuevas opciones farmacológicas para el tratamiento de la diabetes tipo 2 / New treatment options for the type 2 diabetes

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Nuevos enfoques farmacológicos para el riesgo cardiovascular / New pharmacological approaches for cardiovascular risk

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Importancia del peso en el control del paciente con diabetes mellitus tipo 2: hacia una visión adipocéntrica del abordaje de la diabetes / Relevance of weight in the management of patients with type 2 diabetes mellitus: towards an adipocentric approach to diabetes

En las últimas décadas se ha producido en el mundo un incremento paralelo en la prevalencia de obesidad y diabetes mellitus tipo 2, dato no sorprendente si tenemos en cuenta que el aumento de grasa visceral es el principal factor de riesgo para el desarrollo de diabetes mellitus tipo 2 en individuos genéticamente predispuestos. La intervención centrada en el control intensivo de la glucemia en la diabetes mellitus tipo 2 con los tratamientos clásicos aumenta el riesgo de ganancia de peso y aparición de hipoglucemias. Por el contrario, la pérdida de peso mediante cambios en el estilo de vida, fármacos y/o cirugía mejora simultáneamente la mayoríade factores de riesgo cardiovascular, incluida la hiperglucemia. La intervención intensiva sobre el estilo de vida induce un beneficio global en el paciente con diabetes mellitus tipo 2, pero la pérdida ponderal a largo plazo es modesta y no ha demostrado reducir la morbimortalidad cardiovascular. La aparición de nuevos grupos terapéuticos para la diabetes mellitus tipo 2 o la obesidad, que consiguen mejorar simultáneamente la HbA1c, el peso y otros factores de riesgo cardiovascular sin producir hipoglucemias, representa un salto cualitativo en el manejo de los pacientes con diabesidad. Un inhibidor del cotransportador sodio-glucosa tipo 2 y un agonista del receptor de GLP1 recientemente han demostrado reducir la mortalidad cardiovascular y total en la diabetes mellitus tipo 2 con enfermedad cardiovascular. Además, la cirugía bariátrica ha mostrado una rápida remisión de la diabetes mellitus tipo 2 en un gran porcentaje de pacientes y reduce la mortalidad específica para diabetes. La aparición de nuevos tratamientos plantea la posibilidad de cambiar la estrategia terapéutica glucocéntrica actual por una estrategia adipocéntrica (AU)

In recent decades, there has been a worldwide parallel increase in the prevalence of obesity and type 2 diabetes mellitus (T2DM), which is not surprising, given that increased visceral fat is the main risk factor for the development of T2DM in genetically predisposed individuals. An intervention focused on intensive blood glucose control in T2DM with classic drugs increases the risk of weight gain and the rate of hypoglycaemia. In contrast, weight loss through lifestyle changes, drugs and/or surgery simultaneously improves most cardiovascular (CV) risk factors, including hyperglycemia. Intensive intervention on lifestyle induces an overall benefit in patients with T2DM, but long-term weight loss is modest and has not been shown to reduce CV morbidity and mortality. The emergence of new therapeutic classes for T2DM and obesity, which simultaneously improve HbA1c, weight and other CV risk factors without inducing hypoglycaemia, represents a major change in the management of patients with diabesity. A sodium-glucose cotransporter-2 inhibitor and a GLP-1 receptor agonist have recently been shown to decrease CV and total mortality in type 2 diabetic patients with CV disease. Furthermore, bariatric surgery rapidly inducesremission or improvement of T2DM in a large percentage of patients and reduces diabetes-relatedmortality. The emergence of new therapies raises the possibility of changing the current glucose-centred therapeutic strategy for a weight-centred approach (AU)

Tratamiento farmacológico de la obesidad / Pharmacological approaches in obesity treatment

La obesidad es la enfermedad metabólica más prevalente y un factor de riesgo para la aparición de enfermedades cardiovasculares razón por la que debe ser tratada. El tratamiento farmacológico debe entenderse como una medida coadyuvante de los cambios en el estilo de vida que constituyen el primer escalón del tratamiento, estando indicado tan sólo en pacientes obesos y en pacientes con sobrepeso que presentan patologías asociadas (p.ej., hipertensión arterial, diabetes tipo 2 o dislipemias) en los que la dieta y el ejercicio durante los 2-3 meses anteriores han sido inefectivas. Debemos tener presente que los fármacos no curan la obesidad, su efecto a largo plazo es modesto, pueden producir reacciones adversas (a veces graves) y que la interrupción del tratamiento conduce a un rápido aumento del peso corporal En este capítulo analizaremos el tratamiento farmacológico de la obesidad, analizando los objetivos del mismo, las barreras que lo dificultan y la evidencia que avala los fármacos que actualmente han sido aceptados tanto por la Food and Drug Administration de los Estados Unidos y la European Medicines Agency (AU)

Obesity is the most prevalent metabolic disease and a risk factor for cardiovascular diseases and, therefore, it should be treated. Drug treatment should be understood as an adjunctive measure of changes in lifestyle that are the first step of treatment, being indicated only in obese patients and in overweight patients with associated cardiovascular diseases (eg, hypertension, type 2 diabetes or dyslipidemia) when diet and exercise during the previous 2-3 months have been found ineffective. We must remember that drugs do not cure obesity, its long-term effect is modest, they can produce adverse reactions (sometimes severe) and discontinuation of treatment leads to a rapid gain in body weight This chapter discusses the pharmacological treatment obesity, analyses the main objectives of drug therapy, the barriers that hinder the treatment and the evidence supporting the drugs at the present time accepted by the Food and drug Administration and the European medicines Agency (AU)