{"id":10544,"date":"2020-06-19T09:40:43","date_gmt":"2020-06-19T09:40:43","guid":{"rendered":"https:\/\/jurmed.ro\/medici\/?p=10544"},"modified":"2020-06-19T09:40:43","modified_gmt":"2020-06-19T09:40:43","slug":"schimbarea-paradigmei-tratamentului-medicamentos-al-pacientilor-diabetici-cu-risc-cardiovascular-inalt","status":"publish","type":"post","link":"https:\/\/jurmed.ro\/medici\/schimbarea-paradigmei-tratamentului-medicamentos-al-pacientilor-diabetici-cu-risc-cardiovascular-inalt\/","title":{"rendered":"Schimbarea paradigmei tratamentului medicamentos al pacien\u021bilor diabetici cu risc cardiovascular inalt"},"content":{"rendered":"
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Dr. Ioana-Diana Floren\u021biu Medic primar Diabet zaharat, nutri\u021bie \u0219i boli metabolice Centrul Medical Provita<\/em><\/figcaption><\/figure>\n

Diabetul este considerat un factor de risc cardiovascular major. Peste 68% dintre pacien\u021btii diabetici cu v\u00e2rsta peste 65 ani mor datorit\u0103 unei afec\u021biuni cardiace, iar aproximativ 16% decedeaz\u0103 prin accident vascular. Riscul de moarte de cauz\u0103 cardiovascular\u0103 este de 2-4 ori mai mare la adul\u021bii cu diabet comparativ cu cu cei de v\u00e2rst\u0103 similar\u0103 dar f\u0103r\u0103 diabet.<\/p>\n

\u00cen ultimii ani, FDA (US food and drug administration), organismul regulator al medicamentelor din SUA, a cerut studii de siguran\u021b\u0103 cardiovascular\u0103 pentru toate medicamentele noi dezvoltate pentru tratamentul diabetului. Dintre numeroase molecule studiate, 2 clase au dovedit nu doar siguran\u021b\u0103, ci chiar superioritate \u00een preven\u021bia cardiovascular\u0103.<\/p>\n

Numeroasele studii publicate recent, cum ar fi \u201cEmpagliflozin (EMPA) Cardiovascular (CV) Outcome Event Trial in T2DM Patients-Removing Excess Glucose\u201d (EMPA-REG OUTCOME), \u201cLiraglutide Effect and Action in Diabetes: Evaluation of CV Outcome Results,\u201d and \u201cTrial to Evaluate CV and Other Long-term Outcomes with Semaglutide in Subjects with Type 2 Diabetes\u201d (SUSTAIN6), \u201cResearching Cardiovascular Events With a Weekly INcretin in Diabetes\u201d (REWIND<\/em>) au ar\u0103tat mai multe efecte benefice ale liraglutidei, dulaglutidei, semaglutidei, empagliflozinei asupra riscului cardiovascular.<\/p>\n

Cele dou\u0103 clase de medicamente antidiabetice care demonstreaz\u0103 beneficii cardiovasculare sunt agoni\u0219tii de receptor glucagon like 1 (GLP-1) \u0219i inhibitorii de sodiu-glucoza cotransportor 2 (SGLT2).<\/p>\n

Agoni\u0219tii de receptor glucagon like 1 (GLP-1) sau incretin mimeticele sunt agen\u021bi care ac\u021bioneaz\u0103 similar cu hormonii incretinici, cum ar fi peptidul glucagon-like 1. Ei se leag\u0103 de receptorii GLP-1 \u0219i stimuleaz\u0103 secre\u021bia de insulin\u0103 dependent\u0103 de glucoz\u0103, av\u00e2nd astfel un efect antihiperglicemic. Incretin mimeticele reduc apetitul \u0219i inhib\u0103 secre\u021bia de glucagon. Ele \u00eencetinesc golirea stomacului, reduc\u00e2nd astfel glicemia postprandial\u0103. Se administreaz\u0103, de obicei, injectabil cu frecven\u021b\u0103 variabil\u0103 \u00een func\u021bie de preparat, de la 1-2 injec\u021bii pe zi p\u00e2n\u0103 la 1 injec\u021bie pe s\u0103pt\u0103m\u00e2n\u0103. Medicamentele prezente pe pia\u021ba rom\u00e2neasc\u0103 sunt exenatida, exenatida LAR, liraglutida, dulaglutid, lixisenatida.<\/p>\n

Inhibitorii de sodiu-glucozp cotransportor 2 (SGLT2), cunoscu\u021bi \u0219i sub denumirea de gliflozine, inhibp proteinele SGLT2 aflate la nivelul tubulilor renali, responsabile pentru reabsorb\u0219ia glucozei \u00een s\u00e2nge. \u00cen consecin\u021b\u0103, o parte din glucoz\u0103 va fi eliminat\u0103 \u00een urin\u0103. Inhibitorii de SGLT2 sunt eficien\u021bi \u00een sc\u0103derea hemoglobinei glicate, reducerea greut\u0103\u021bii corporale \u0219i a tensiunii arteriale. Sunt bine tolera\u021bi \u00een general \u0219i au posibilitatea de a ac\u021biona indiferent de capacitatea func\u021biei beta-celulare a pancreasului. Reprezentan\u021bii clasei (prezen\u021bi \u00een Rom\u00e2nia) sunt dapagliflozina \u0219i empagliflozina.<\/p>\n

Ambele clase de medicamente prezint\u0103 un risc sc\u0103zut de hipoglicemie.<\/p>\n

Consensul ADA\/EASD 2018 pentru tratamenul hiperglicemiei \u00een diabetul zaharat de tip 2 accentueaz\u0103 necesitatea reducerii riscului cardiovascular, consider\u00e2ndu-l parte integrant\u0103 din managementul diabetului zaharat. Astfel, exist\u0103 o sec\u021biune dedicat\u0103 pacien\u021bilor cu risc cardiovascular \u00eenalt, afla\u021bi \u00een preven\u021bie secundar\u0103. \u00cen timp ce metforminul r\u0103m\u00e2ne \u00een continuare prima linie de tratament, \u00een cazul acestor pacien\u021bi, medica\u021bia de elec\u021bie pentru linia a doua de tratament trebuie s\u0103 fac\u0103 parte din aceste clase de medicamente detaliate mai sus.<\/p>\n

Mai precis, \u00een cazul pacien\u021bilor cu boal\u0103 cardiovascular\u0103 aterosclerotic\u0103 dovedit\u0103, de prim\u0103 inten\u021bie sunt agoni\u0219tii de GLP-1 cu beneficiu dovedit \u00een studii clinice (liraglutid, semaglutid, dulaglutid, exenatida LAR). Studiile care au stat la baza acestor recomand\u0103ri au ar\u0103tat beneficii precum reducerea mortalit\u0103\u021bii de orice cauz\u0103, reducerea num\u0103rului de evenimente cardiovasculare majore, reducerea riscului de moarte de cauz\u0103 cardiovascular\u0103 \u0219i reducerea riscului de accident vascular ischemic. Pentru pacien\u021bii cu insuficien\u021b\u0103 cardiac\u0103 \u0219i\/sau boal\u0103 renal\u0103 cronic\u0103 progresiv\u0103 se recomand\u0103 un inhibitor de SGLT-2 (empagliflozina, canagliflozina, dapagliflozina). Ace\u0219tia reduc semnificativ riscul de spitalizare prin insuficien\u021b\u0103 cardiac\u0103 \u0219i deces cardiovascular prin mecanisme \u00eenc\u0103 incomplet \u00een\u021belese \u0219i, de asemenea, riscul de progresie a bolii renale cronice.<\/p>\n

\u00cen concluzie, odat\u0103 diagnosticat\u0103 boala aterosclerotic\u0103, insuficien\u021ba cardiac\u0103 sau boala renal\u0103 cronic\u0103 la un pacient cu diabet zaharat de tip 2, tratamentul antidiabetic poate completa \u00een mod firesc tratamentul prescris de medicul cardiolog sau nefrolog. \u00ce acest mod, prin alegerea terapiei potrivite fiec\u0103rui pacient, medicul diabetolog poate contribui la reducerea\/ameliorarea prognosticului acestor comorbidit\u0103\u021bi importante.<\/p>\n

\n","protected":false},"excerpt":{"rendered":"

Diabetul este considerat un factor de risc cardiovascular major. Peste 68% dintre pacien\u021btii diabetici cu v\u00e2rsta peste 65 ani mor datorit\u0103 unei afec\u021biuni cardiace, iar aproximativ 16% decedeaz\u0103 prin accident […]<\/p>\n","protected":false},"author":4,"featured_media":10546,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[282],"tags":[],"class_list":["post-10544","post","type-post","status-publish","format-standard","has-post-thumbnail","category-diabet"],"yoast_head":"\nSchimbarea paradigmei tratamentului medicamentos al pacien\u021bilor diabetici cu risc cardiovascular inalt - Jurmed - Medici<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/jurmed.ro\/medici\/schimbarea-paradigmei-tratamentului-medicamentos-al-pacientilor-diabetici-cu-risc-cardiovascular-inalt\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Schimbarea paradigmei tratamentului medicamentos al pacien\u021bilor diabetici cu risc cardiovascular inalt - Jurmed - Medici\" \/>\n<meta property=\"og:description\" content=\"Diabetul este considerat un factor de risc cardiovascular major. 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