ABSTRACT
Obesity is a chronic, recurring, progressive disease and a major public health problem associated with several other diseases that lead to disability, morbidity, and mortality. The prevalence of obesity has increased at pandemic levels, along with increasing weight-related comorbidities and deaths worldwide. Lifestyle interventions alone provide clinically significant long-term weight loss in only a small proportion of individuals, and bariatric surgery is not suitable or desirable for all patients. Historically, anti-obesity medications achieved a mean efficacy with weight loss between 5 and 10%, which significantly impacted several comorbidities and risk factors, but the average efficacy of these medications remained lower than that expected by both patients and health care professionals and eventually curbed long-term use. Moreover, there is no direct evidence on the impact of anti-obesity medications on cardiovascular outcomes. Semaglutide is a newer anti-obesity medication that changes the overall landscape, as phase 3 studies show a mean weight loss near the 15% threshold and significant proportions of patients with a weight loss of greater than 20%. In this review, we focus on the currently available anti-obesity medications, discuss the results of semaglutide, and present perspectives on the future of obesity treatment after semaglutide.
ABSTRACT
Resumen La diabetes mellitus tipo 2 es una de las enfermedades metabólicas que afecta a diferentes órganos, uno en el cual es el riñón. Una de las principales complicaciones microvasculares es la nefropatía diabética, siendo la principal causa de insuficiencia renal crónica a nivel mundial. De ahí la importancia de las recomendaciones en la utilización o no de los fármacos antihiperglicemiantes, basadas en sus efectos beneficiosos a nivel de la función renal en relación con la tasa de filtración glomerular estimada y la relación albumina/creatinina en pacientes con diabetes mellitus tipo 2 y enfermedad renal. En estudios recientes se han evaluado antihiperglicemiantes con un impacto beneficioso a nivel de desenlaces cardiovascular y renal. En el presente artículo se revisan las acciones y los efectos de los diferentes grupos de medicamentos como la metformina, los inhibidores de la dipeptidil peptidasa 4, los agonistas de la GLP-1, tiazolidinedionas, sulfonilureas, inhibidores del cotransportador de sodio-glucosa tipo 2 e insulinas en la función renal en cuanto a las dosis de cada fármaco, tanto el uso de dosis establecidas, disminución de la dosis o el no uso del medicamento con base en el empeoramiento de la tasa de filtración glomerular estimada. Con respecto a la metodología aplicada para el desarrollo del artículo, se seleccionó artículos a partir de palabras claves como diabetes mellitus tipo 2, antihiperglicemiantes en la función renal, tasa de filtración glomerular estimada y relación albumina/creatinina; se emplearon artículos de revistas reconocidas que no superaran 5 años en su publicación, sin embargo, se utilizaron artículos que superaran este tiempo, dado que aportaban datos importantes para el artículo de revisión.
Abstract Type 2 diabetes mellitus is one of the metabolic diseases that affects different organs, one of which is the kidney. One of the main microvascular complications is diabetic nephropathy, being the main cause of chronic renal failure worldwide. Hence the importance of recommendations on the use or non-use of antihyperglycemic drugs based on their beneficial effects on kidney function, expressed by the estimated glomerular filtration rate and the albumin / creatinine ratio in patients with type 2 diabetes mellitus and kidney disease. Recent studies have shown antihyperglycemic agents with beneficial impact in cardiovascular and renal endpoints. In the present article we will review the actions and effects of different groups of drugs such as metformin, inhibitors of dipeptidyl peptidase 4, GLP-1 agonists, thiazolidinediones, sulfonylureas, SGLT-2 inhibitors and insulins in renal function in relation to the doses of each drug, both the use of established doses, reduction of the dose or non-use of the drug based on the worsening of the estimated glomerular filtration rate. With respect to the methodology applied for the development of the article, a selection of articles was made based on key words such as type 2 diabetes mellitus, antihyperglycemic agents in renal function, estimated glomerular filtration rate and albumin/ creatinine ratio. Prestigious journal articles were used with less than 5 years since its publication, however articles that exceed this time were used as they provided important data in the review article.