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Diabetes de mellitus tipo 2: eficácia e efetividade dos inibidores SGLT-2
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A Diabetes Mellitus tipo 2 é um problema de saúde pública global em ascensão. Trata-se de
uma das doenças crónicas mais comuns, que atinge indiscriminadamente ambos os géneros e
todas as idades, sendo considerada por muitos especialistas a epidemia do século XXI, dado o
aumento exponencial de prevalência que se tem vindo a verificar ao longo dos últimos anos. A
morbilidade e mortalidade que lhe é inerente, bem como o resultante impacto negativo na
sociedade, na economia e sobretudo no doente tornam o problema de gestão da Diabetes
Mellitus tipo 2 um desafio colossal para todos os clínicos e entidades envolvidas nesse processo.
Este flagelo está ainda intimamente ligado à epidemia da obesidade, da hipertensão e das
doenças cardiovasculares e renais.
Daí urge a necessidade de articular e reunir esforços a fim de tentar encontrar alternativas
terapêuticas cada vez mais eficazes e seguras, que atuem em várias frentes na etiopatogenia da
doença, de modo a coibir a sua evolução natural e otimizar a qualidade de vida do doente.
Nessa linha de pensamento encaixam os inibidores do cotransportador de sódio-glucose 2, uma
classe farmacológica relativamente recente que possui um mecanismo de ação muito diferente
dos demais agentes redutores de glucose. Ao contrário destes os inibidores do cotransportador
de sódio-glucose 2 oferecem um mecanismo independente de insulina, promovem a excreção
urinária de glucose ao inibir a sua reabsorção no rim, o que leva consequentemente a uma
redução dos níveis de glucose no sangue com o risco mínimo de hipoglicemia.
Com o presente trabalho pode constatar-se que os inibidores do cotransportador de sódio-glucose 2 constituem uma alternativa terapêutica eficaz e efetiva para o controlo dos níveis de
glucose, quer em monoterapia, quer em terapia de associação com outros agentes antidiabéticos.
Além disso as evidências demonstraram que estes fármacos possuem efeitos benéficos
adicionais no que diz respeito à redução do peso corporal, redução da pressão arterial,
diminuição da mortalidade global, diminuição da hospitalização por insuficiência cardíaca e
redução da progressão da doença renal crónica, levando à sua primazia e dissipando-se assim a
lacuna existente entre os ensaios clínicos aleatorizados e a prática clínica de rotina.
Type 2 diabetes is a growing public health problem. It is one of the most common chronic diseases, affecting indiscriminately both genders and all age groups. Many experts consider it to be the epidemic of the 21st century, given the exponential increase in prevalence over the last years. The inherent morbidity and mortality, as well as the resulting negative impact on society, economy and on the patient, make the type 2 diabetes management a colossal challenge for all clinicians and entities involved in this process. This disease is also associated with other comorbidities such as obesity, hypertension, cardiovascular and renal disease. Hence the urgent need to articulate and join efforts to find increasingly effective and safe therapeutic alternatives, which act on several fronts in the etiopathogenesis of the disease, in order to slow or stop the progression of the ilness and optimize the patient’s quality of life. In this line of thought are the sodium-glucose cotransporter 2 inhibitors, a relatively recent pharmacological class that has a very different mechanism of action from other glucosereducing agents. These drugs have an insulin-independent mechanism of action, they promote urinary glucose excretion by inhibiting its absorption in the kidney, which consequently leads to a reduction of blood glucose levels. The risk of hypoglycimia is minimal in this type of medication. With the present work it is evident that sodium-glucose cotransporter 2 inhibitors are an effective therapeutic alternative for the control of glycaemia, either in monotherapy or in combination therapy with other antidiabetic agents. Furthermore, evidence have shown that these drugs have additional beneficial effects in reducing body wheight, lowering blood pressure, decreasing overall mortality and hospitalization by heart failure, and reducing the progression of chronic kidney disease. Ultimately, this leads to its primacy and thus bridging the gap between randomized clinical trials and routine clinical practice.
Type 2 diabetes is a growing public health problem. It is one of the most common chronic diseases, affecting indiscriminately both genders and all age groups. Many experts consider it to be the epidemic of the 21st century, given the exponential increase in prevalence over the last years. The inherent morbidity and mortality, as well as the resulting negative impact on society, economy and on the patient, make the type 2 diabetes management a colossal challenge for all clinicians and entities involved in this process. This disease is also associated with other comorbidities such as obesity, hypertension, cardiovascular and renal disease. Hence the urgent need to articulate and join efforts to find increasingly effective and safe therapeutic alternatives, which act on several fronts in the etiopathogenesis of the disease, in order to slow or stop the progression of the ilness and optimize the patient’s quality of life. In this line of thought are the sodium-glucose cotransporter 2 inhibitors, a relatively recent pharmacological class that has a very different mechanism of action from other glucosereducing agents. These drugs have an insulin-independent mechanism of action, they promote urinary glucose excretion by inhibiting its absorption in the kidney, which consequently leads to a reduction of blood glucose levels. The risk of hypoglycimia is minimal in this type of medication. With the present work it is evident that sodium-glucose cotransporter 2 inhibitors are an effective therapeutic alternative for the control of glycaemia, either in monotherapy or in combination therapy with other antidiabetic agents. Furthermore, evidence have shown that these drugs have additional beneficial effects in reducing body wheight, lowering blood pressure, decreasing overall mortality and hospitalization by heart failure, and reducing the progression of chronic kidney disease. Ultimately, this leads to its primacy and thus bridging the gap between randomized clinical trials and routine clinical practice.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2020, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Diabetes mellitus Tipo 2 Inibidores do cotransportador de sódio-glucose 2 Dapagliflozina Empagliflozina Canagliflozina Ertugliflozina Eficácia Efetividade Resultados cardiovasculares e renais Mestrado integrado - 2020