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1.
Chemistry ; 26(11): 2456-2463, 2020 Feb 21.
Artículo en Inglés | MEDLINE | ID: mdl-31889346

RESUMEN

Polyamine-salt aggregates (PSA) are biomimetic soft materials that have attracted great attention due to their straightforward fabrication methods, high drug-loading efficiencies, and attractive properties for pH-triggered release. Herein, a simple and fast multicomponent self-assembly process was used to construct cross-linked poly(allylamine hydrochloride)/phosphate PSAs (hydrodynamic diameter of 360 nm) containing glucose oxidase enzyme, as a glucose-responsive element, and human recombinant insulin, as a therapeutic agent for the treatment of diabetes mellitus (GI-PSA). The addition of increasing glucose concentrations promotes the release of insulin due to the disassembly of the GI-PSAs triggered by the catalytic in situ formation of gluconic acid. Under normoglycemia, the GI-PSA integrity remained intact for at least 24 h, whereas hyperglycemic conditions resulted in 100 % cargo release after 4 h of glucose addition. This entirely supramolecular strategy presents great potential for the construction of smart glucose-responsive delivery nanocarriers.


Asunto(s)
Sistemas de Liberación de Medicamentos , Glucosa/química , Insulina/administración & dosificación , Insulina/química , Nanocápsulas/química , Poliaminas/química , Reactivos de Enlaces Cruzados/química , Diabetes Mellitus/tratamiento farmacológico , Gluconatos/química , Humanos , Insulina/farmacología
4.
Biosci Biotechnol Biochem ; 84(3): 598-605, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31724491

RESUMEN

Red kidney beans (Phaseolus vulgaris L.) contain bioactive compounds that are known to exhibit antidiabetic effects via inhibition of α-glucosidase. However, information on the nonpolar components that exhibit antidiabetic activity is limited. Here, we report the isolation and structure determination of components with α-glucosidase inhibitory activity, which were obtained from the hexane extract of red kidney beans. Triacylglycerols (TAGs) were identified as the major components exhibiting inhibitory activity against α-glucosidase. The chemical structure of TAGs was determined by a combination of GC-MS and UPLC-MS/MS. The primary TAGs identified were LnLnLn (trilinolenin) and LnLLn (1,3-dilinolenoyl-2-linoleoyl glycerol). The major fatty acids present in these TAGs were α-linolenic acid (ω-3) and linoleic acid (ω-6). These TAGs were also found to inhibit the α-glucosidase activity in a similar fashion as acarbose. These results suggest that TAGs have potency as antidiabetics and support the potential suitability of red kidney beans for diabetes treatment.


Asunto(s)
Inhibidores de Glicósido Hidrolasas/aislamiento & purificación , Hexanos/química , Phaseolus/química , Triglicéridos/aislamiento & purificación , Cromatografía Liquida/métodos , Diabetes Mellitus/tratamiento farmacológico , Ácidos Grasos/análisis , Cromatografía de Gases y Espectrometría de Masas , Inhibidores de Glicósido Hidrolasas/química , Inhibidores de Glicósido Hidrolasas/farmacología , Inhibidores de Glicósido Hidrolasas/uso terapéutico , Estructura Molecular , Espectrometría de Masas en Tándem , Triglicéridos/química
5.
Life Sci ; 240: 117090, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31765648

RESUMEN

Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are a relatively newer class of anti-hyperglycemic medications that reduce blood glucose by inhibition of renal glucose re-uptake, thereby increasing urinary glucose excretion. Although glycosuria is the primary mechanism of action of these agents, there is some evidence suggesting they can reduce insulin resistance and induce peripheral insulin sensitivity. Identifying the molecular mechanisms by which these medications improve glucose homeostasis can help us to develop newer forms of SGLT2i with lesser side effects. We have reviewed the molecular mechanisms and signaling pathways by which SGLT2i therapy improve insulin sensitivity and ameliorates insulin resistance.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/metabolismo , Hipoglucemiantes/farmacología , Resistencia a la Insulina , Inhibidores del Cotransportador de Sodio-Glucosa 2/uso terapéutico , Transportador 2 de Sodio-Glucosa/metabolismo , Animales , Humanos , Hipoglucemiantes/uso terapéutico
6.
Life Sci ; 240: 117138, 2020 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-31809715

RESUMEN

Pyroptosis is a form of cell death mediated by gasdermin D (GSDMD); it is characterised by NLRP3 inflammasome activation, caspase activation, cell membrane pore formation, and the release of interleukin-1ß and interleukin-18. NLRP3 inflammasome activation plays a central role in pyroptosis. Recent research has suggested that NLRP3 inflammasome activation may be involved in the occurrence and development of diabetes mellitus and its associated complications. This finding provided the impetus for us to clarify the significance of pyroptosis in diabetes. In this review, we summarise the current understanding of the molecular mechanisms involved in pyroptosis, as well as recent advances in the role of NLRP3 inflammasome activation and pyroptosis in the development of diabetes and diabetic complications.


Asunto(s)
Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/genética , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/genética , Inflamasomas/genética , Proteína con Dominio Pirina 3 de la Familia NLR/genética , Piroptosis/genética , Animales , Complicaciones de la Diabetes/patología , Diabetes Mellitus/patología , Humanos , Inflamasomas/efectos de los fármacos , Piroptosis/efectos de los fármacos
7.
Phytomedicine ; 66: 153107, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31790903

RESUMEN

BACKGROUND: Gomisin A is a lignan isolated from the hexane of Schisandra chinensis fruit extract with antioxidant properties. Oxidative stress mediated by high glucose is one of the major complications of diabetes mellitus. PURPOSE: This study investigates the role of gomisin A in osteoblast differentiation under high glucose-induced oxidative stress in MC3T3 E1 cells and determines its relationship with heme oxygenase-1 (HO-1) and mitochondrial biogenesis. METHODS: MC3T3 E1 cells were treated by gomisin A following induced by high glucose levels and glucose oxidase to investigate the inhibitory effect of gomisin A against high glucose oxidative stress. Western blot analysis, alizarin red staining, alkaline phosphatase (ALP) activity, analysis of reactive oxygen species (ROS) and confocal microscopy were used to determine mitochondrial biogenesis, oxidative stress, osteoblast differentiation and mineralization. To analyze the role of HO-1, the MC3T3 E1 cells were treated with the HO-1 inhibitor zinc protoporphyrin IX (ZnPP). RESULTS: Gomisin A enhanced the expression of HO-1, increased mitochondrial biogenesis factors (peroxisome proliferator-activated receptor gamma coactivator 1-alpha, nuclear respiratory factor-1, and mitochondrial transcription factor A), antioxidant enzymes (copper-zinc superoxide dismutases and manganese superoxide dismutase), osteoblast differentiation molecules (bone morphogenic protein-2/7, osteoprotegerin and Runt-related transcription factor-2) and mineralization by upregulation of ALP and alizarin red staining, which were decreased by ZnPP and high glucose oxidative stress. Similarly, gomisin A inhibited ROS which was increased by ZnPP and the high glucose-mediated oxidative stress. CONCLUSIONS: The findings demonstrated the antioxidative effects of gomisin A, and its role in mitochondrial biogenesis and osteoblast differentiation. It potentially regulated osteoblast differentiation under high glucose-induced oxidative stress via upregulation of HO-1 and maintenance of mitochondrial homeostasis. Thus, gomisin A may represent a potential therapeutic agent for prevention of bone fragility fractures and implant failure triggered by diabetes.


Asunto(s)
Antioxidantes/farmacología , Ciclooctanos/farmacología , Diabetes Mellitus/tratamiento farmacológico , Dioxoles/farmacología , Glucosa/efectos adversos , Lignanos/farmacología , Osteogénesis/efectos de los fármacos , Schisandra/química , Animales , Diferenciación Celular/efectos de los fármacos , Regulación de la Expresión Génica , Hemo-Oxigenasa 1/metabolismo , Homeostasis/efectos de los fármacos , Humanos , Ratones , Mitocondrias/efectos de los fármacos , Mitocondrias/metabolismo , Biogénesis de Organelos , Osteoblastos/efectos de los fármacos , Osteoblastos/fisiología , Estrés Oxidativo/efectos de los fármacos , Protoporfirinas/farmacología , Especies Reactivas de Oxígeno/metabolismo
8.
Food Chem ; 311: 125948, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-31877545

RESUMEN

The increasing incidence of metabolic syndrome requires more functional food products with low cost and excellent effects to assist treatment. The crude extract of Moringa oleifera Lam. showed excellent hypoglycemic activity. The current study was designed to investigate the effects and mechanism of niazirin, a bioactive component from Moringa oleifera Lam. seed, on diabetic metabolic syndrome. C57BL/6J mice were treated daily with 5 mL/kg/body weight (BW) of saline, while db/db mice were similarly treated with 5 mL/kg/BW of saline, 10 and 20 mg/kg/BW of niazirin, respectively. Results indicated that niazirin could significantly reduce body weight, water and food intake, improve hyperglycemia, insulin resistance, inflammation, carbohydrate and lipid metabolism, non-alcoholic fatty liver. Furthermore, niazirin improved the hepatic energy metabolism via AMPK signaling pathway. Our study provides an evidence of an edible plant product, niazirin, may help in the treatment of metabolic syndrome.


Asunto(s)
Proteínas Quinasas Activadas por AMP/metabolismo , Diabetes Mellitus/tratamiento farmacológico , Glicósidos/administración & dosificación , Hipoglucemiantes/administración & dosificación , Metabolismo de los Lípidos/efectos de los fármacos , Moringa oleifera/química , Fenoles/administración & dosificación , Extractos Vegetales/administración & dosificación , Proteínas Quinasas Activadas por AMP/genética , Animales , Diabetes Mellitus/genética , Diabetes Mellitus/metabolismo , Humanos , Resistencia a la Insulina , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Ratones , Ratones Endogámicos C57BL , Semillas/química
10.
BMC Infect Dis ; 19(1): 1039, 2019 Dec 09.
Artículo en Inglés | MEDLINE | ID: mdl-31818258

RESUMEN

BACKGROUND: Ligands of the receptor for advanced glycation end products (RAGE) are key signalling molecules in the innate immune system but their role in tuberculosis-diabetes comorbidity (TB-DM) has not been investigated. METHODS: We examined the systemic levels of soluble RAGE (sRAGE), advanced glycation end products (AGE), S100A12 and high mobility group box 1 (HMGB1) in participants with either TB-DM, TB, DM or healthy controls (HC). RESULTS: Systemic levels of AGE, sRAGE and S100A12 were significantly elevated in TB-DM and DM in comparison to TB and HC. During follow up, AGE, sRAGE and S100A12 remained significantly elevated in TB-DM compared to TB at 2nd month and 6th month of anti-TB treatment (ATT). RAGE ligands were increased in TB-DM individuals with bilateral and cavitary disease. sRAGE and S100A12 correlated with glycated hemoglobin levels. Within the TB-DM group, those with known diabetes (KDM) revealed significantly increased levels of AGE and sRAGE compared to newly diagnosed DM (NDM). KDM participants on metformin treatment exhibited significantly diminished levels of AGE and sRAGE in comparison to those on non-metformin regimens. CONCLUSIONS: Our data demonstrate that RAGE ligand levels reflect disease severity and extent in TB-DM, distinguish KDM from NDM and are modulated by metformin therapy.


Asunto(s)
Antígenos de Neoplasias/sangre , Diabetes Mellitus/tratamiento farmacológico , Metformina/uso terapéutico , Proteínas Quinasas Activadas por Mitógenos/sangre , Proteína S100A12/sangre , Tuberculosis Pulmonar/sangre , Adulto , Anciano , Antituberculosos/uso terapéutico , Estudios de Casos y Controles , Comorbilidad , Diabetes Mellitus/sangre , Diabetes Mellitus/epidemiología , Femenino , Productos Finales de Glicación Avanzada/sangre , Proteína HMGB1/sangre , Humanos , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Regulación hacia Arriba
11.
Rev Lat Am Enfermagem ; 27: e3217, 2019.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-31826159

RESUMEN

OBJECTIVE: to characterize and determine the polypharmacy prevalence in patients with chronic diseases and to identify the factors associated, in order to improvement of pharmaceutical care focused on patient safety. METHODS: cross-sectional study included 558 patients, covered by primary health care, using a household and structured questionnaire. We analyzed the data on polypharmacy and its clinical and socioeconomic factors. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio. RESULTS: the results showed that polypharmacy (consumption of four or more drugs) was of 37.6%. The prevalence ratio analyses identified independent variables associated with polypharmacy: age (3.05), economic strata (0.33), way of medication acquisition through a combination of out-of-pocket and Brazilian public health system (1.44), diabetes and hypertension (2.11), comorbidities (coronary artery disease 2.26) and hospital admission (1.73). In the analyses, inappropriate medication use of the 278 patients (≥ 65 years) was associated with polypharmacy (prevalence ratio 4.04). CONCLUSION: polypharmacy study becomes an opportunity to guide the strategies for the patient safety to promote the medication without harm in chronic diseases.


Asunto(s)
Enfermedad Crónica/tratamiento farmacológico , Polifarmacia , Lista de Medicamentos Potencialmente Inapropiados/estadística & datos numéricos , Adolescente , Adulto , Anciano , Brasil , Enfermedad Crónica/clasificación , Comorbilidad , Estudios Transversales , Diabetes Mellitus/tratamiento farmacológico , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prevalencia , Atención Primaria de Salud , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
12.
Rev Med Chil ; 147(5): 668-672, 2019 May.
Artículo en Español | MEDLINE | ID: mdl-31859901

RESUMEN

Autoimmune pancreatitis is uncommon, responds to steroids and is usually associated with diabetes mellitus. We report a 73 year-old male who, two months after a diagnosis of diabetes mellitus, presented with obstructive jaundice and weight loss. Abdominal magnetic resonance imaging was suggestive of an autoimmune pancreatitis and serum IgG4 was 339 mg/dl (normal range 3-201). The patient was treated with prednisone 40 mg/day with a good clinical and laboratory response. During outpatient care, the dose of prednisone was tapered.


Asunto(s)
/complicaciones , Complicaciones de la Diabetes , Diabetes Mellitus , Glucocorticoides/uso terapéutico , Prednisona/uso terapéutico , Anciano , Complicaciones de la Diabetes/complicaciones , Complicaciones de la Diabetes/tratamiento farmacológico , Diabetes Mellitus/tratamiento farmacológico , Humanos , Hipoglucemiantes/uso terapéutico , Inmunoglobulina G/sangre , Insulina/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Resultado del Tratamiento
13.
Zhongguo Zhong Yao Za Zhi ; 44(18): 3895-3898, 2019 Sep.
Artículo en Chino | MEDLINE | ID: mdl-31872721

RESUMEN

The application of classical formula in the treatment of diabetes has a long history. Zhang Zhongjing set up a special chapter on consumptive thirst in Synopsis of the Golden Chamber,listing Baihu Jia Renshen Decoction for exuberant heat in the lung and stomach,dual deficiency of Qi and Yin syndrome,and Shenqi Pills for kidney Qi deficiency syndrome. However,the clinical application is not limited to them. In this study,formulas of Huanglian,Dahuang,Chaihu,Gualougen,Lingzhu,Huangqi and Dihuang are listed as the main therapeutic methods for diabetes mellitus,with effects in clearing heat,dredging the bowels and purging turbid,clearing depression and dispersing knots,nourishing Yin and quenching thirst,invigorating spleen and draining dampness,supplementing Qi and tonifying deficiency,nourishing Yin and tonifying kidney,which have the advantages for the treatment of diabetes and its complications. Based on accurate differentiation of symptoms and signs,consideration shall be given to both " of diseases and syndromes",while emphasis shall be given to the " main symptoms",so as to flexibly apply classical formula and expand the scope of application.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Medicamentos Herbarios Chinos/uso terapéutico , Humanos , Riñón , Pulmón , Medicina China Tradicional , Fitoterapia
14.
Pan Afr Med J ; 33: 309, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692777

RESUMEN

Introduction: Adherence to insulin therapy is a critical factor for adequate control of diabetes mellitus. Despite the multiple well-known benefits of adherence to insulin therapy, poor adherence remains to be a common cause of diabetes mellitus-related complications. A better management of diabetes mellitus requires determining the level of patient adherence and identifying why non-adherence to insulin therapy occurs. Therefore, this study was designed to assess the level of adherence to insulin therapy and associated factors among diabetes mellitus patients. Methods: The study was conducted from May 1 to July 1, 2018, using a cross-sectional study design. Interviewer-administered questionnaire was employed for data collection and systematic random sampling technique was used to select study participants. The collected data were entered using Epi data version 3.1.1 and exported to SPSS version 22 for analysis. Logistic analysis was carried out to check the level of association between adherence to insulin therapy and the independent variables with significance level of 0.05 at 95% confidence interval. Results: 273 respondents were selected with a 100% response rate. Near to one-fourth (24.2%) of the respondents were adherent to their insulin therapy. The study revealed that good knowledge of diabetes mellitus [AOR=6.51; 95% CI [1.58, 26.71], age [>30 years] [AOR=2.63; 95% CI [1.27, 5.42], knowledge regarding insulin self-injection [AOR=4.21; 95%CI [1.06,16.65], favorable attitude towards insulin injection [AOR=2.14; 95% CI [1.04,4.41], free-of-cost insulin therapy [AOR= 4.62, 95% CI [1.06,16.65], having of glucometer at home [AOR= 2.82, 95% CI [1.12,7.09], and being a member of Ethiopian diabetic association [AOR= 5.41, 95% CI [2.31,12.64] were found to significantly affect adherence to insulin therapy. Conclusion: Nearly one-fourth of the study participants were adherent to their insulin therapy. Good knowledge and favorable attitude towards insulin injection, good knowledge regarding diabetes mellitus, being a member of the Ethiopian Diabetes Association, age greater than thirty years old, free-of-cost insulin therapy and having glucometer at home were found to be significant predictors of adherence to insulin therapy.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Cumplimiento de la Medicación/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Etiopía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Hospitales Públicos , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Autoadministración , Encuestas y Cuestionarios , Adulto Joven
15.
Life Sci ; 239: 117011, 2019 Dec 15.
Artículo en Inglés | MEDLINE | ID: mdl-31669241

RESUMEN

Diabetes mellitus (DM) is a multifaceted and costly disease, which requires serious attention. Finding a cheaper anti-diabetic alternative that can act on multiple disease-related targets and pathways is the ultimate treatment goal for DM. Nanotechnology has offered some exciting possibilities in biomedical and drug delivery applications. Zinc oxide nanoparticles (ZnO-NPs), a novel agent to deliver zinc, have great implications in many disease therapies including DM. This review summarizes the pharmacological mechanisms by which ZnO-NPs alleviate DM and diabetic complications. Research implications and future perspectives were also discussed.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Nanopartículas del Metal/uso terapéutico , Óxido de Zinc/uso terapéutico , Animales , Complicaciones de la Diabetes/tratamiento farmacológico , Sistemas de Liberación de Medicamentos , Humanos , Hipoglucemiantes/farmacología , Óxido de Zinc/farmacología
17.
Medicine (Baltimore) ; 98(47): e17976, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31764805

RESUMEN

BACKGROUND: According to the centers for disease control and prevention, 14% of American adults have diabetes - 10% know it, and more than 4% go undiagnosed. Sotagliflozin is a new type of diabetes drug This study is to compare the efficacy of Sotagliflozin therapy for Diabetes Mellitus (DM) between week 24 with week 52. METHODS AND ANALYSIS: Through to October 2019, Web of Science, PubMed Database, Cochrane Library, EMBASE, Clinical Trials and CNKI will be searched to identify randomized controlled trials (RCTs) exploring SOTA therapy for DM. Strict screening and quality evaluation will be performed on the obtained literature independently by 2 researchers; outcome indexes will be extracted. The bias risk of the included studies will be evaluated based on Cochrane assessment tool. Meta-analysis will be performed on the data using Revman 5.3 software. We will provide practical and targeted results assessing the lost efficacy of SOTA therapy for DM from week 24 to week 52, to provide reference for clinicians. ETHICS AND DISSEMINATION: The stronger evidence about the lost efficacy of SOTA for DM from week 24 to week 52 will be provided for clinicians. TRIAL REGISTRATION NUMBER: PROSPERO CRD42019133027. STRENGTHS AND LIMITATIONS OF THIS STUDY: Whether the efficacy of SOTA could last for a long time is still inconclusive, high quality research is still lacking, and this study attempts to explore this issue; The efficacy of SOTA at different times will be compared by direct comparisons and indirect comparisons, this can lead to more accurate and reliable results; The quality of the included literatures are uneven, and some data might be estimated by calculation, which may affect the quality of this study.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Glicósidos/administración & dosificación , Metaanálisis como Asunto , Metaanálisis en Red , Proyectos de Investigación , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Esquema de Medicación , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Tiempo , Resultado del Tratamiento
18.
Int J Nanomedicine ; 14: 7503-7513, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31686818

RESUMEN

Background: The high lifetime risk of vascular disease is one of the important issues that plague patients with diabetes mellitus. Systemic oral vildagliptin administration favors endothelial recovery and inhibits smooth muscle cell (SMC) proliferation. However, the localized release of vildagliptin in the diabetic vessel damage has seldom been investigated. Research design and methods: In this work, nanofiber-eluting stents that loaded with vildagliptin, a dipeptidyl peptidase-4 enzyme (DPP-4) inhibitor, was fabricated to treat diabetic vascular disease. To prepare nanofibers, the poly (D,L)-lactide-co-glycolide (PLGA) and vildagliptin were mixed using hexafluoroisopropanol and electrospinning process. In vitro and in vivo release rates of the vildagliptin were characterized using high-performance liquid chromatography. Results: Effective vildagliptin concentrations were delivered for more than 28 days from the nanofibrous membranes coating on the surface of the stents in vitro and in vivo. The vildagliptin-eluting PLGA membranes greatly accelerated the recovery of diabetic endothelia and reduced SMC hyperplasia. The type I collagen content of the diabetic vascular intimal area that was treated by vildagliptin-eluting stents was lower than that of the non-vildagliptin-eluting group. Conclusion: The experimental results revealed that stenting with vildagliptin-eluting PLGA membranes could potentially promote healing for diabetic arterial diseases.


Asunto(s)
Diabetes Mellitus/tratamiento farmacológico , Stents Liberadores de Fármacos , Endotelio/patología , Nanofibras/química , Neointima/tratamiento farmacológico , Vildagliptina/uso terapéutico , Animales , Aorta/efectos de los fármacos , Aorta/patología , Colágeno Tipo I/metabolismo , Endotelio/efectos de los fármacos , Células Endoteliales de la Vena Umbilical Humana/efectos de los fármacos , Humanos , Masculino , Nanofibras/ultraestructura , Conejos , Vildagliptina/farmacología
19.
Buenos Aires; Argentina. Ministerio de Salud y Desarrollo Social. Secretaria de Gobierno de Salud. Comisión Nacional de Evaluación de Tecnologías Sanitarias; nov. 2019. 100 p. tabs.
Monografía en Español | BRISA/RedTESA | ID: biblio-1046385

RESUMEN

INTRODUCCIÓN: El objetivo del presente informe es evaluar la eficacia, seguridad y costos de todos los tratamientos para DMT2. La evidencia incluida demostró que existe un beneficio menor entre los tratamientos, con diferencias poco importantes para mortalidad por cualquier causa o de origen cardiovascular, eventos adversos serios y complicaciones macrovasculares. El análisis de impacto presupuestario de elaboración propia demostró que el impacto sería no favorable a la incorporación de todos tratamientos evaluados. El impacto en la equidad es probablemente positivo para las sulfonilureas y tiazolidinedionas, sin impacto para los inhibidores de la enzima dipeptidil-peptidasa 4 e inhibidores del cotransportador-2 de sodio-glucosa y probablemente negativo para los agonistas del receptor del péptido-1 símil glucagón, insulinas y análogos de insulina. El impacto en la salud pública se consideró que no tendría impacto para las sulfonilureas y tiazolidinedionas, y que sería probablemente negativo para el resto. DESCRIPCIÓN DE LA TECNOLOGÍA: Las SU estimulan la secreción de insulina, por lo que son útiles solo en pacientes con alguna función residual de células beta del páncreas. El receptor de SU en estas células es un componente del canal de potasio sensible al trifosfato de adenosina (canal K-ATP), el cual regula la liberación de insulina. La unión de las SU conduce a la inhibición de estos canales, lo que altera el potencial de reposo de la célula y conduce a la estimulación de la secreción de insulina.El efecto neto es una mayor capacidad de respuesta de las células beta a los secretagogos de glucosa y no glucosa (como los aminoácidos), lo que resulta en la liberación de más insulina en todas las concentraciones de glucosa en sangre. MÉTODOS: BÚSQUEDA BIBLIOGRÁFICA: Se buscó en Pubmed, Lilacs, BRISA ­redetsa-, CRD (del inglés Centre for Reviews and Dissemination- University of York), Cochrane; "buscadores genéricos de internet" y sociedades científicas. En lo que respecta a agencias de ETS, se buscó en: NICE (del inglés, National Institute for Health and Clinical Excellence); PBAC (del inglés, The Pharmaceutical Benefits Advisory Committee); CADTH (del inglés, Canadian Agency for Drugs and Technologies in Health) y CONITEC (Comissão Nacional de Incorporação de Tecnologías no SUS). RESULTADOS: EVIDENCIA CLÍNICA: Se incluyeron al presente informe siete RS con MA, cinco MA en red, sieteGPC, un consenso de expertos, doce informes de ETS, tres evaluaciones económicas, un análisis de impacto presupuestario (AIP) de elaboración propia, 138 políticas de coberturas para el tratamiento farmacológico de adultos con diabetes mellitus tipo 2. CONCLUSIÓN: El diagnóstico de diabetes afecta a todos los integrantes de la familia y de los cuidadores por lo tanto la actitud de los mismos es crucial para el manejo cotidiano de la diabetes. Se resaltan tres factores fundamentales que aseguran la adherencia al tratamiento y la mejora de la calidad de vida de los pacientes con diabetes tipo dos: información (del paciente y de su entorno), motivación y acceso. El acceso a estos tratamientos para los pacientes que son intolerantes o refractarios a la metformina soluciona parte del problema de equidad y es importante en cuanto a las problemáticas de salud pública ya que afecta a un número considerable de la población y favorecería a las poblaciones más vulnerables. Sin embargo, no se llega a zanjar las inequidades existentes en cuanto al acceso a la alimentación saludable, a la actividad física y a los controles médicos con especialistas.


Asunto(s)
Epidemiología , Diabetes Mellitus , Diabetes Mellitus/tratamiento farmacológico , Quimioterapia , Evaluación de la Tecnología Biomédica
20.
Am Surg ; 85(10): 1184-1188, 2019 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-31657321

RESUMEN

Guidelines suggest targeting a preoperative international normalized ratio (INR) < 1.5. We examined and compared the predictive value of INR relative to the Model for End-Stage Liver Disease (MELD). We reviewed the American College of Surgeons NSQIP from 2005 to 2016 for adult patients undergoing open or laparoscopic cholecystectomy. Patients with a preoperative INR were stratified into groups: ≤1, >1 to ≤1.5, >1.5 to ≤2, and >2. Thirty day postoperative mortality was the primary outcome. Multivariable logistic regressions controlled for baseline differences. Of 58,177 cholecystectomy patients, 15.2 per cent had INR ≤ 1, 80.4 per cent had INR > 1 to ≤1.5, 3.7 per cent had INR > 1.5 to ≤2, and 0.7 per cent had INR > 2. Patients with INR > 2 were older and more likely to have diabetes and hypertension (P < 0.001). Multivariable regression demonstrated a stepwise increase in mortality for INR > 1 to ≤1.5 (odds ratio (OR) = 1.50 [1.10-2.05]), INR > 1.5 to ≤2 (OR = 2.96 [1.97-4.45]), and INR > 2 (OR = 3.21 [1.64-6.31]) relative to INR ≤ 1. C-statistic for INR (0.910) and MELD (0.906) models indicated a similar value in predicting mortality. INR groups also faced an incremental, increased risk of bleeding. Although unable to track preoperative correction of INR, this analysis identifies that INR remains an excellent predictor of postoperative mortality and bleeding after both open and laparoscopic cholecystectomies and is comparable to MELD.


Asunto(s)
Colecistectomía/mortalidad , Enfermedad Hepática en Estado Terminal/sangre , Enfermedad Hepática en Estado Terminal/mortalidad , Relación Normalizada Internacional/mortalidad , Adulto , Factores de Edad , Análisis de Varianza , Colecistectomía Laparoscópica/mortalidad , Diabetes Mellitus/tratamiento farmacológico , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/cirugía , Femenino , Humanos , Hipertensión/tratamiento farmacológico , Relación Normalizada Internacional/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/mortalidad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo
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