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1.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33526523

RESUMEN

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, which are used for treatment of type 2 diabetes, are associated with risk of urogenital infections. FDA issued a black box warning about multiple case reports of Fournier's gangrene (FG) observed in patients taking SGLT2 inhibitors. FG is a type of necrotising fasciitis that occurs in the anogenital area. We report a case of a 71-year-old woman with type 2 diabetes on dapagliflozin, presenting with foul-smelling discharge and a large abscess in the perianal area. Her risk factors for FG included her advanced age, obesity, diabetes and trauma to the site. During her stay, dapagliflozin was discontinued and she received procedural debridement, wound care and broad-spectrum intravenous antibiotics. Due to possible association between FG and SGLT2 inhibitors, patients presenting with signs and symptoms of FG who are taking SGLT2 inhibitors should be examined for infection in the urogenital area and treated promptly.


Asunto(s)
Absceso/inducido químicamente , Accidentes por Caídas , Compuestos de Bencidrilo/efectos adversos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Gangrena de Fournier/inducido químicamente , Glucósidos/efectos adversos , Perineo/lesiones , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Absceso/terapia , Anciano , Antibacterianos/uso terapéutico , Desbridamiento , Diabetes Mellitus Tipo 2/complicaciones , Drenaje , Femenino , Gangrena de Fournier/terapia , Hospitales Rurales , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Linagliptina/uso terapéutico , Obesidad/complicaciones , Compuestos de Sulfonilurea/uso terapéutico
2.
BMJ Case Rep ; 14(2)2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33526518

RESUMEN

Immune checkpoint inhibitors (ICIs) are increasingly used to treat certain malignancies due to their higher efficacy compared with conventional chemotherapy. As familiarity with these agents increases, it is becoming apparent that a significant number of patients treated with ICIs experience adverse events. With time, more immune-related adverse events (IRAEs) are being recognised. It is important to be vigilant for IRAEs and recognise that a patient may have multiple IRAEs affecting multiple organ systems. Common cardiovascular adverse events associated with ICIs include myocarditis, arrhythmias and pericarditis. This case report identifies a patient presenting with takotsubo syndrome followed by ketoacidosis (associated with sodium-glucose transport protein 2 (SGLT2) inhibitor) in the setting of combination ipilimumab and nivolumab therapy for metastatic melanoma.


Asunto(s)
Neoplasias Encefálicas/tratamiento farmacológico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Cetoacidosis Diabética/inducido químicamente , Melanoma/tratamiento farmacológico , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos , Cardiomiopatía de Takotsubo/inducido químicamente , Anciano , Compuestos de Bencidrilo/efectos adversos , Neoplasias Encefálicas/complicaciones , Neoplasias Encefálicas/secundario , Angiografía Coronaria , Diabetes Mellitus Tipo 2/complicaciones , Cetoacidosis Diabética/complicaciones , Ecocardiografía , Glucósidos/efectos adversos , Humanos , Ipilimumab/efectos adversos , Imagen por Resonancia Magnética , Masculino , Melanoma/complicaciones , Melanoma/secundario , Nivolumab/efectos adversos , Cardiomiopatía de Takotsubo/complicaciones , Cardiomiopatía de Takotsubo/diagnóstico por imagen
3.
Medicine (Baltimore) ; 100(3): e23918, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545962

RESUMEN

BACKGROUND: Obesity is an independent risk factor for the occurrence and development of diabetes. Patients with diabetes combined with obesity will face serious burdens such as increase in insulin resistance and difficulty in blood glucose control. As a safe, effective, economical, and simple intervention, Tuina is more acceptable to the public than drugs. The objective of this systematic evaluation and meta-analysis is to evaluate the efficacy and safety of Tuina for diabetes with obesity. METHODS: We will search the following electronic databases: PubMed, Embase, Cochrane Library, Web of science, Chinese National Knowledge Infrastructure (CNKI), Sino Med, Wanfang, Chinese Clinical Trial Registry System, China Biomedical Literature Database (CBM). The time limit for retrieving studies is from establishment to November 2020 for each database. Randomized controlled clinical trials related to Tuina intervention on diabetes with obesity will be included. Data synthesis, sensitivity analysis, subgroup analysis as well as the assessment of bias risk will be conducted by using Stata V.13.0 and Review manager 5.3 software. RESULTS: This study will provide a quantitative and standardized evaluation for the efficacy of Tuina therapy on diabetes with obesity. CONCLUSION: This systematic review and meta-analysis will provide the high-quality evidence of whether Tuina is an effective intervention for diabetes with obesity. REGISTRATION NUMBER: INPLASY2020110106.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Obesidad Mórbida , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
4.
Medicine (Baltimore) ; 100(6): e23843, 2021 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-33578512

RESUMEN

BACKGROUND: Diabetes refers to any group of metabolic diseases characterized by high blood sugar and generally thought to be caused by insufficient production of insulin, impaired response to insulin. Globally, patients with type 2 diabetes account for more than 85% of the total diabetic patients, and due to factors, such as obesity, aging, environment and lifestyle, the incidence of diabetes is rising. Salvia miltiorrhiza (SM) is a medicine used to treat diabetes in China. In recent years, it has been reported that SM has the effect of improving type 2 diabetes. However, there is no systematic review of its efficacy and safety yet. Therefore, we propose a systematic review to evaluate the efficacy and safety of SM for T2D. METHODS: Six databases will be searched: China National Knowledge Infrastructure (CNKI), China Biological Medicine (CBM), China Scientific Journals Database (CSJD), Wanfang database, PubMed, and EMBASE. The information is searched from January 2010 to July 2020. Languages are limited to English and Chinese. The primary outcomes include 2 hour plasma glucose, fasting plasma glucose, hemoglobin A1c, homeostasis model assessment of insulin resistance, and fasting plasma insulin. The secondary outcomes include clinical efficacy and adverse events. RESULTS: This systematic review will evaluate the efficacy and safety of Salvia miltiorrhiza in the treatment of type 2 diabetes. CONCLUSION: This systematic review provides evidence as to whether Salvia miltiorrhiza is effective and safe for type 2 diabetes. ETHICS: Ethical approval is not necessary as this protocol is only for systematic review and does not involve in privacy data or an animal experiment. SYSTEMATIC REVIEW REGISTRATION: INPLASY2020110046.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Salvia miltiorrhiza/química , China/epidemiología , Manejo de Datos , Diabetes Mellitus Tipo 2/epidemiología , Ayuno/sangre , Femenino , Glucosa/análisis , Hemoglobina A Glucada/análisis , Homeostasis/efectos de los fármacos , Humanos , Incidencia , Insulina/sangre , Masculino , Medicina China Tradicional/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Seguridad , Resultado del Tratamiento
5.
J Assoc Physicians India ; 69(2): 25-29, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33527807

RESUMEN

Achieving adequate glycemic control in type 2 diabetes mellitus (T2DM) remains a difficult but achievable goal. Oral agents (OADs) are important option for management of T2DM. Most T2DM patients require more than one medication for adequate glycemic control. Metformin based combination therapy is recommended when monotherapy is insufficient. Evogliptin is a recently developed dipeptidyl peptidase-4 (DPP-4) inhibitor, which can to be combined with metformin for treating T2DM. Combination therapy of Evogliptin and Metformin lowers blood glucose via augmentation of insulin secretion, suppression of glucagon secretion, and insulin sensitization. Co-administration of Evogliptin and Metformin showed no clinically relevant pharmacokinetic differences compared to the administration of each drug alone. Combination therapy of Evogliptin and Metformin also provides significantly better glycemic control compared to the respective monotherapies. Efficacy and safety of Evogliptin and Metformin had been demonstrated in several multicentre randomized clinical trials conducted in various countries like South Korea, Russia and India. Consequently, fixed dose combination (FDC) of Evogliptin and Metformin is approved in South Korea and India. Complexity of the treatment regimen and polypharmacy are well-known factors of poor medication adherence and FDCs have the potential to improve adherence by reducing the pill burden. Adoption of this combination therapy in clinical practice for management of T2DMs will provide a greater degree of HbA1c reduction than that observed with the use of either drug as monotherapy, and is unlikely to cause significant hypoglycemia. Combination therapy of Evogliptin and Metformin is a promising strategy in the treatment of T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2 , Inhibidores de la Dipeptidil-Peptidasa IV , Metformina , Glucemia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Quimioterapia Combinada , Hemoglobina A Glucada , Humanos , Hipoglucemiantes/uso terapéutico , India , Metformina/uso terapéutico , Piperazinas , Federación de Rusia
6.
Medicine (Baltimore) ; 100(3): e23948, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33545972

RESUMEN

BACKGROUND: Recently, many clinical experiments have evaluated the influences of liraglutide in the treatment of type 2 diabetes. However, the outcomes of these studies are inconsistent, and the number of high-quality prospective trials that conducted to assess the cardiovascular safety is limited. Hence, for this research, it was implemented for the assessment of the cardiovascular effectiveness and safety of liraglutide in type 2 diabetes patients. METHODS: This research was a 26-week active controlled and randomized trial. Our research protocol follows the guidelines of Good Clinical Practice issued via the Helsinki Declaration and International Conference on Coordination. All the patients will receive the written informed consent in order to involve in our clinical experiment. The participants with type 2 diabetes aged from 18 years to 80 years, patients with 45.0 kg/m2 body-mass index or less, and with glycosylated hemoglobin of 7.5 to 10.0 percent, and received metformin (daily 1500 mg or more) for 3 months or longer were eligible. All the patients were randomized to 1 of 2 interventions (in the ratio of 1:1): liraglutide placebo once daily (blinded) and liraglutide once daily (blinded), respectively, both combined with the glimepiride and metformin (open-labeled). For the efficacy variable, the major endpoint was the baseline glycated hemoglobin change after treating for 26 weeks. The secondary end points involved: the percentage of participants who achieved the goals of postprandial blood glucose, fasting blood glucose, and glycosylated hemoglobin; the changes of mean postprandial blood glucose, fasting blood glucose, and the body weight, pancreatic B-cell function index, and changes in blood pressure and insulin resistance assessed by homeostasis model. CONCLUSIONS: For this research, the limitations involve the short trial period and the limitation of glimepiride in some countries, thus excluding the maximum doses of glimepiride. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry6306).


Asunto(s)
Cardiotoxicidad/clasificación , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Liraglutida/uso terapéutico , Protocolos Clínicos , Diabetes Mellitus Tipo 2/fisiopatología , Humanos , Hipoglucemiantes/efectos adversos , Hipoglucemiantes/farmacología , Hipoglucemiantes/uso terapéutico , Liraglutida/efectos adversos , Liraglutida/farmacología , Ensayos Clínicos Controlados Aleatorios como Asunto
8.
Rev Med Liege ; 76(1): 7-12, 2021 Jan.
Artículo en Francés | MEDLINE | ID: mdl-33443322

RESUMEN

Sulphonylureas (SU) for a long time occupied an essential role in the management of type 2 diabetes (T2D). However, the launch of new oral antidiabetic drugs (OAD), firstly DPP-4 inhibitors (gliptins) and more recently SGLT2 inhibitors (gliflozins), has markedly changed the scene. Indeed, in contrast to SU, these new OAD (of course more expensive) offer the advantage of a very low risk of hypoglycaemia and a beneficial impact on bodyweight. Furthermore, gliflozins have proven to exert a cardiovascular and renal protection in patients at high risk. SU keep a place in the management of T2D, yet it becomes more and more limited. For sure, SU should be avoided among elderly frailty people and patients at high risk of hypoglycaemia.


Asunto(s)
Diabetes Mellitus Tipo 2 , Inhibidores de la Dipeptidil-Peptidasa IV , Inhibidores del Cotransportador de Sodio-Glucosa 2 , Anciano , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Inhibidores de la Dipeptidil-Peptidasa IV/uso terapéutico , Humanos , Hipoglucemiantes/efectos adversos , Compuestos de Sulfonilurea
9.
Sr Care Pharm ; 36(2): 112-121, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33509335

RESUMEN

Hypoglycemia in the older population is a significant problem accounting for increased hospitalizations, emergency room visits, health care costs, and decreased quality of life. Older patients are more susceptible to hypoglycemia because of the increased prevalence of comorbidities requiring multiple medications, age-related physiologic changes, and a progressive decline in health. Older patients are less likely to present with symptoms of hypoglycemia and symptoms may frequently appear at a lower threshold of blood glucose than in younger patients. Consequently, preventing and treating hyperglycemia in older patients can be challenging. If mismanaged, the impact of hypoglycemia in these patients can lead to acute and chronic negative outcomes. Insulin and sulfonylureas should be closely monitored, and deprescribing should be routinely considered in older patients at high risk for hypoglycemia.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemia/prevención & control , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Anciano , Anciano de 80 o más Años , Glucemia/efectos de los fármacos , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Cuidados a Largo Plazo , Pacientes Ambulatorios , Farmacéuticos , Calidad de Vida , Compuestos de Sulfonilurea
11.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33461993

RESUMEN

Exenatide is a subcutaneous injectable glucagon-like peptide 1 receptor agonist that has been approved by the Federal Drug Administration for the treatment of type 2 diabetes mellitus. While side effects such as nausea, vomiting and local hypersensitivity reactions are more commonly described, angio-oedema has never been previously reported in the literature. We present the case of a 67-year-old woman who presented to the emergency department with acute-onset tongue swelling, difficulty breathing, dizziness and diffuse itching which began shortly after receiving her first dose of intramuscular extended release (ER) exenatide. This case aims to raise awareness of the potential adverse effect of angio-oedema secondary to exenatide ER and serves as a reminder to clinicians to discuss possible adverse effects of medications and early recognition of symptoms which would prompt further medical attention.


Asunto(s)
Angioedema/inducido químicamente , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Exenatida/efectos adversos , Hipoglucemiantes/efectos adversos , Anciano , Angioedema/diagnóstico , Exenatida/uso terapéutico , Femenino , Humanos , Hipoglucemiantes/uso terapéutico
12.
Rev Med Liege ; 76(1): 64-68, 2021 Jan.
Artículo en Francés | MEDLINE | ID: mdl-33443332

RESUMEN

Development of new insulins aims to mimic in a better way the natural physiology of this hormone secreted by the pancreas. Rapid insulin analogues have proven a better capacity to reduce postprandial glycaemic peaks after eating. Nevertheless, these molecules are still quite inaccurate to limit glycaemic excursions after the meals. This reality is often described by patients using continuous glucose monitoring systems. So, there is undeniably a place for even more rapid insulins. The ones named «ultra-rapid insulin¼ tend to better control hyperglycaemia after meals thanks to more favourable profiles regarding pharmacodynamics and pharmacokinetics. Ultra-rapid lispro (URLi) Lyumjev®, is the new ultra-rapid insulin available in Belgium. This review aims to describe its advantages compared to some other rapid insulins thanks to data obtained from trials in type 1 and type 2 diabetes.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Bélgica , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemiantes/uso terapéutico , Insulina , Insulina Lispro
13.
Anticancer Res ; 41(2): 821-828, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517287

RESUMEN

BACKGROUND/AIM: Preclinical studies on metformin use and endometrial cancer have been promising but epidemiological studies have reported variable results. This study aimed to assess if metformin use is associated with endometrial cancer aggressiveness and survival in women with type 2 diabetes (T2D). PATIENTS AND METHODS: This retrospective hospital-based cohort consisted of women with T2D who were treated for endometrial cancer at the Oulu University Hospital, Finland, between 2007 and 2014. RESULTS: The sample size was 121 patients: 58 metformin users and 63 metformin non-users. Intriguingly, type 2 histology, deep myometrial invasion and the presence of lymphovascular invasion were more common in the metformin user group. However, metformin use showed no association with overall survival and progression-free survival. CONCLUSION: Metformin use was associated with poorer prognostic factors in endometrial cancer patients with T2D.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Neoplasias Endometriales/patología , Hipoglucemiantes/uso terapéutico , Metformina/uso terapéutico , Anciano , Anciano de 80 o más Años , Neoplasias Endometriales/mortalidad , Femenino , Finlandia , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Estudios Retrospectivos , Análisis de Supervivencia
14.
Medicine (Baltimore) ; 100(2): e23743, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466125

RESUMEN

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is a metabolic disease characterized by high blood sugar caused by impaired insulin action. With an increasing incidence year by year, it has become a worldwide epidemic. Because of its serious, long-term condition, T2DM has a bad impact on the life and well-being of individuals, families and society. Renshen and Huanglian or compound prescription contain Renshen and Huanglian for treatment of T2DM has already been confirmed. However, due to the lack of evidence, there is no specific method or suggestion, so it is necessary to carry out systematic evaluation on Renshen and Huanglian and provide effective evidence for further research. METHODS AND ANALYSIS: We will search English databases (PubMed, Embase, Web of Science, Nature, Science on line, the Cochrane Library) and Chinese databases (CNKI, Wan Fang, VIP, Chinese biomedical database), from the establishment of database to October 2020, for randomized controlled trials (RCTs) of ginseng and coptis and the compound containing ginseng and coptis in the treatment of T2DM. Primary outcomes: fasting blood-glucose (FBG), 2 Hours Postprandial Blood Glucose (2hPBG), Glycosylated hemoglobin A1c (HbA1c). Additional outcomes: Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), triglycerides (TG), total serum cholesterol (TC). Two researchers independently extracted the data and evaluated the quality of the included research, and meta-analysis was conducted on the included data using the software of RevMan5.3 and Stata V.12.0. RESULTS: The results of this study will systematically evaluate the effectiveness and safety of Renshen and Huanglian intervention for people with T2DM. CONCLUSION: The systematic review of this study will summarize the current published evidence of Renshen and Huanglian or compound prescription contain Renshen and Huanglian for the treatment of T2DM, which can further guide the promotion and application of it. ETHICS AND DISSEMINATION: This study is a systematic review; the outcomes are based on the published evidence, so examination and agreement by the ethics committee are not required in this study. We intend to publish the study results in a journal or conference presentations. OPEN SCIENCE FRAMEWORK OSF REGISTRATION NUMBER: October 18, 2020. osf.io/8gz7c (https://osf.io/8gz7c).


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Hipoglucemiantes/uso terapéutico , Panax , Glucemia/efectos de los fármacos , Quimioterapia Combinada , Medicamentos Herbarios Chinos/administración & dosificación , Medicamentos Herbarios Chinos/efectos adversos , Hemoglobina A Glucada/efectos de los fármacos , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Estilo de Vida , Lípidos/sangre , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación
15.
Monaldi Arch Chest Dis ; 91(1)2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33501821

RESUMEN

Dear Editor, The Corona virus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in the Wuhan province of china in December 2019. COVID-19 spread to the world in a short time and was declared as public health emergency of international concern by World Health Organization...


Asunto(s)
Diabetes Mellitus Tipo 2 , Hemoglobina A Glucada/análisis , Pulmón , Terapia por Inhalación de Oxígeno/métodos , Anciano , /diagnóstico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Resultado Fatal , Fibrosis/diagnóstico , Fibrosis/etiología , Fibrosis/terapia , Servicios de Atención de Salud a Domicilio , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Masculino , Factores de Riesgo , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
16.
Rev Med Suisse ; 17(723): 188-191, 2021 Jan 27.
Artículo en Francés | MEDLINE | ID: mdl-33507658

RESUMEN

Diabetes is a rapidly evolving discipline, numerous new molecules and recommendations are available. However, these rapid changes are sometimes difficult to follow for general practitioners. Metformin remains the cornerstone of type 2 diabetes treatment after lifestyle modifications, which should always be encouraged before medications. Currently, the best classes to add after metformin seem to be SGLT2 inhibitors and GLP-1 receptor agonists, as these molecules showed some cardiovascular and renal beneficial effects in dedicated studies. Nevertheless, the current pharmacological plethora is paradoxically associated with clinical inertia as general practitioners may be in trouble finding the right medication. This article will highlight novelties in the field of diabetes during the year 2020.


Asunto(s)
Diabetes Mellitus Tipo 2 , Médicos Generales , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Humanos , Hipoglucemiantes/uso terapéutico , Metformina , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico
17.
Lakartidningen ; 1182021 01 20.
Artículo en Sueco | MEDLINE | ID: mdl-33474717

RESUMEN

Continuous glucose monitoring (CGM) tracks glucose levels in real-time using a subcutaneous sensor, replacing intermittent blood sampling for self-monitoring of blood glucose (SMBG). CGM is a routine tool in type 1 diabetes management. In 2019, patients with type 2 diabetes were given the indication of CGM use by Swedish authorities; CGM can be considered when a patient despite multi-dose treatment with insulin does not achieve good glucose control and/or has problems with hypoglycaemia. Studies show that CGM provides improved glycaemic control compared to SMBG. The cost of CGM is higher than for SMBG and requires effort both by caregivers and patients. This should be gauged against the possible long-term health economic benefits of preventing diabetes complications.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Hipoglucemia , Glucemia , Automonitorización de la Glucosa Sanguínea , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Humanos , Hipoglucemia/inducido químicamente , Hipoglucemia/prevención & control
18.
Medicine (Baltimore) ; 100(1): e24101, 2021 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-33429775

RESUMEN

BACKGROUND: To evaluate dapagliflozin, canagliflozin, empagliflozin, ertugliflozin, and sotagliflozin according to their effect on the glycated hemoglobin A1c (HbA1c) level in patients with type 2 diabetes mellitus. METHODS: The Web of Science, PubMed, Cochrane Library, EMBASE, and Clinical Trials databases were electronically searched to collect randomized controlled trials of patients with type 2 diabetes mellitus through June 2020. Two researchers independently screened and evaluated the obtained studies and extracted the outcome indexes. RevMan 5.3 software was used to perform the meta-analysis and to create plots. RESULTS: Finally, 27 studies were selected and included in this study. The meta-analysis results showed that sodium-dependent glucose transporter (SGLT) inhibitors significantly reduced the HbA1c level in patients with type 2 diabetes mellitus. However, these results were highly heterogeneous, so we conducted a subgroup analysis. The results of the subgroup analysis suggested that by dividing populations into different subgroups, the heterogeneity of each group could be reduced. CONCLUSIONS: SGLT inhibitors had a good effect on the HbA1c level in patients with type 2 diabetes mellitus, but there might be differences in the efficacy of SGLT inhibitors in different populations. It is hoped that more studies will be conducted to evaluate the efficacy and safety of SGLT inhibitors in different populations. REGISTRATION NUMBER: CRD42020185025.


Asunto(s)
Hemoglobina A Glucada/análisis , Inhibidores del Cotransportador de Sodio-Glucosa 2/normas , Compuestos de Bencidrilo/farmacología , Compuestos de Bencidrilo/normas , Compuestos de Bencidrilo/uso terapéutico , Glucemia/análisis , Compuestos Bicíclicos Heterocíclicos con Puentes/farmacología , Compuestos Bicíclicos Heterocíclicos con Puentes/normas , Compuestos Bicíclicos Heterocíclicos con Puentes/uso terapéutico , Canagliflozina/farmacología , Canagliflozina/normas , Canagliflozina/uso terapéutico , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glucósidos/farmacología , Glucósidos/normas , Glucósidos/uso terapéutico , Glicósidos/farmacología , Glicósidos/normas , Glicósidos/uso terapéutico , Humanos , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Factores de Tiempo
19.
BMJ ; 372: m4743, 2021 01 13.
Artículo en Inglés | MEDLINE | ID: mdl-33441384

RESUMEN

OBJECTIVE: To determine the efficacy and safety of low carbohydrate diets (LCDs) and very low carbohydrate diets (VLCDs) for people with type 2 diabetes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Searches of CENTRAL, Medline, Embase, CINAHL, CAB, and grey literature sources from inception to 25 August 2020. STUDY SELECTION: Randomized clinical trials evaluating LCDs (<130 g/day or <26% of a 2000 kcal/day diet) and VLCDs (<10% calories from carbohydrates) for at least 12 weeks in adults with type 2 diabetes were eligible. DATA EXTRACTION: Primary outcomes were remission of diabetes (HbA1c <6.5% or fasting glucose <7.0 mmol/L, with or without the use of diabetes medication), weight loss, HbA1c, fasting glucose, and adverse events. Secondary outcomes included health related quality of life and biochemical laboratory data. All articles and outcomes were independently screened, extracted, and assessed for risk of bias and GRADE certainty of evidence at six and 12 month follow-up. Risk estimates and 95% confidence intervals were calculated using random effects meta-analysis. Outcomes were assessed according to a priori determined minimal important differences to determine clinical importance, and heterogeneity was investigated on the basis of risk of bias and seven a priori subgroups. Any subgroup effects with a statistically significant test of interaction were subjected to a five point credibility checklist. RESULTS: Searches identified 14 759 citations yielding 23 trials (1357 participants), and 40.6% of outcomes were judged to be at low risk of bias. At six months, compared with control diets, LCDs achieved higher rates of diabetes remission (defined as HbA1c <6.5%) (76/133 (57%) v 41/131 (31%); risk difference 0.32, 95% confidence interval 0.17 to 0.47; 8 studies, n=264, I2=58%). Conversely, smaller, non-significant effect sizes occurred when a remission definition of HbA1c <6.5% without medication was used. Subgroup assessments determined as meeting credibility criteria indicated that remission with LCDs markedly decreased in studies that included patients using insulin. At 12 months, data on remission were sparse, ranging from a small effect to a trivial increased risk of diabetes. Large clinically important improvements were seen in weight loss, triglycerides, and insulin sensitivity at six months, which diminished at 12 months. On the basis of subgroup assessments deemed credible, VLCDs were less effective than less restrictive LCDs for weight loss at six months. However, this effect was explained by diet adherence. That is, among highly adherent patients on VLCDs, a clinically important reduction in weight was seen compared with studies with less adherent patients on VLCDs. Participants experienced no significant difference in quality of life at six months but did experience clinically important, but not statistically significant, worsening of quality of life and low density lipoprotein cholesterol at 12 months. Otherwise, no significant or clinically important between group differences were found in terms of adverse events or blood lipids at six and 12 months. CONCLUSIONS: On the basis of moderate to low certainty evidence, patients adhering to an LCD for six months may experience remission of diabetes without adverse consequences. Limitations include continued debate around what constitutes remission of diabetes, as well as the efficacy, safety, and dietary satisfaction of longer term LCDs. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020161795.


Asunto(s)
Diabetes Mellitus Tipo 2/dietoterapia , Dieta Baja en Carbohidratos , Carbohidratos de la Dieta/administración & dosificación , Glucemia/metabolismo , Terapia Combinada , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Dieta Baja en Carbohidratos/efectos adversos , Hemoglobina A Glucada/metabolismo , Humanos , Resistencia a la Insulina , Cooperación del Paciente , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del Tratamiento , Pérdida de Peso
20.
BMJ ; 372: m4573, 2021 01 13.
Artículo en Inglés | MEDLINE | ID: mdl-33441402

RESUMEN

OBJECTIVE: To evaluate sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes at varying cardiovascular and renal risk. DESIGN: Network meta-analysis. DATA SOURCES: Medline, Embase, and Cochrane CENTRAL up to 11 August 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials comparing SGLT-2 inhibitors or GLP-1 receptor agonists with placebo, standard care, or other glucose lowering treatment in adults with type 2 diabetes with follow up of 24 weeks or longer. Studies were screened independently by two reviewers for eligibility, extracted data, and assessed risk of bias. MAIN OUTCOME MEASURES: Frequentist random effects network meta-analysis was carried out and GRADE (grading of recommendations assessment, development, and evaluation) used to assess evidence certainty. Results included estimated absolute effects of treatment per 1000 patients treated for five years for patients at very low risk (no cardiovascular risk factors), low risk (three or more cardiovascular risk factors), moderate risk (cardiovascular disease), high risk (chronic kidney disease), and very high risk (cardiovascular disease and kidney disease). A guideline panel provided oversight of the systematic review. RESULTS: 764 trials including 421 346 patients proved eligible. All results refer to the addition of SGLT-2 inhibitors and GLP-1 receptor agonists to existing diabetes treatment. Both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure (high certainty evidence). Notable differences were found between the two agents: SGLT-2 inhibitors reduced mortality and admission to hospital for heart failure more than GLP-1 receptor agonists, and GLP-1 receptor agonists reduced non-fatal stroke more than SGLT-2 inhibitors (which appeared to have no effect). SGLT-2 inhibitors caused genital infection (high certainty), whereas GLP-1 receptor agonists might cause severe gastrointestinal events (low certainty). Low certainty evidence suggested that SGLT-2 inhibitors and GLP-1 receptor agonists might lower body weight. Little or no evidence was found for the effect of SGLT-2 inhibitors or GLP-1 receptor agonists on limb amputation, blindness, eye disease, neuropathic pain, or health related quality of life. The absolute benefits of these drugs vary substantially across patients from low to very high risk of cardiovascular and renal outcomes (eg, SGLT-2 inhibitors resulted in 5 to 48 fewer deaths in 1000 patients over five years; see interactive decision support tool (https://magicevidence.org/match-it/200820dist/#!/) for all outcomes. CONCLUSIONS: In patients with type 2 diabetes, SGLT-2 inhibitors and GLP-1 receptor agonists reduced cardiovascular and renal outcomes, with notable differences in benefits and harms. Absolute benefits are determined by individual risk profiles of patients, with clear implications for clinical practice, as reflected in the BMJ Rapid Recommendations directly informed by this systematic review. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019153180.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Receptor del Péptido 1 Similar al Glucagón/agonistas , Hipoglucemiantes/uso terapéutico , Mortalidad , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Humanos , Hipoglucemiantes/efectos adversos , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Insuficiencia Renal/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/efectos adversos
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