Terapêutica farmacológica com SGLT2i no controlo da diabetes mellitus tipo 2 e na obesidade associada

Authors

  • Luiz Miguel Santiago Faculdade de Medicina da Universidade de Coimbra Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra USF Topázio, ACES Baixo Mondego http://orcid.org/0000-0002-9343-2827
  • Mariana Pinto Faculdade de Medicina da Universidade de Coimbra. Coimbra, Portugal.
  • Barbara Oliveiros Assistant Professor. Faculdade de Medicina da Universidade de Coimbra. Coimbra, Portugal.

DOI:

https://doi.org/10.32385/rpmgf.v40i2.13647

Keywords:

Diabetes mellitus tipo 2, Inibidores da SGLT2, Tratamento farmacológico, Obesidade, Controlo

Abstract

Aim: To compare obesity progression and the Type2 Diabetes mellitus (T2DM) metabolic control between 2017 and 2019, according to pharmacological therapy with Sodium-Glucose Cotransporter Type 2 inhibitors (SGLT2i) or not in the T2DM of the Central Administrative Portuguese National Health Service Authority, the “ARS do Centro”.

Methodology: Observational retrospective cohort study in 2021 of data by the Informatic Services of ARS do Centro, after ethics consent: gender, age, year of ICPC2 T90 classification, abdominal perimeter (AP), body mass index (BMI), last glycated haemoglobin (HbA1c) in 2017 and 2019 and drugs registered in the e.registration official program, the S-clínico Diabetes.

Results: Out of the 127062 T2DM patients of the ARS do Centro n=16012 (12,6%) were on SGLT2i in 2017. Mean age was of 73.5±10.1 years, the time since ICPC classification was of 8.7±4.2 years and 48.8% were males. HbA1C, BMI and AP values between 2017 and 2019 were independent for age and time since diagnosis, |rS| <0.400. Median HbA1c values between the two moments, in the total sample and in the subgroups medicated with SGLT2i and per gender were significantly different (p<0.001) values increasing. In the subgroups not SGLT2i treated, no difference was observed, either globally (p=0.983) or per gender (M: p=0.932; F: p=0.932). BMI in SGLT2i treated T2DM showed significant negative variation (p<0.001) also observed in nonSGLT2i treated ones (p=0.004). AP values significantly increased in nonSGLT2i T2DM patients (p=0.001) and significantly decreased in the SGLT2i treated ones (p<0.001).

Discussion:  The efficacy of SGLT2i in clinical assays in real world patients, effectiveness, must be ascertained. Obesity decrease can contribute to future T2DM control.

Conclusion: SGLT2i significantly decreased BMI and prevented AP increase, when compared with non-SGLT2 T2DM patients. HbA1c control, in a 2-year gap showed no decrease in growth. Anti-diabetes medicine frequency of knowledge must be ameliorated.

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Author Biography

  • Luiz Miguel Santiago, Faculdade de Medicina da Universidade de Coimbra Clínica Universitária de Medicina Geral e Familiar da Faculdade de Medicina da Universidade de Coimbra USF Topázio, ACES Baixo Mondego

    Luiz Miguel de Mendonça Soares Santiago é Licenciado em Medicina pela Universidade de Coimbra desde 1979, Mestre em Saúde Pública pela Universidade de Coimbra desde 2006 e Doutorado por unanimidade com distinção e louvor, pela Universidade de Coimbra, na Especialidade de Sociologia Médica, ramo de Medicina Preventiva e Comunitária desde 11/11/2009.

    É desde1/7/2017 Professor Associado da Faculdade de Medicina da Universidade de Coimbra, regendo as Unidades Curriculares de MISP IV, 3º Ano e de Medicina Geral e Familiar, 5º Ano.

    Desde 30 de Janeiro de 2018 tem o título de "Agregado".

    Médico, especialista em Medicina Geral e Familiar, é Consultor com o Grau de Assistente Graduado Sénior da Carreira de Medicina Geral e Familiar desde 2002, sendo orientador no Internato Complementar de Medicina Geral e Familiar desde 2006, tendo exercido na Unidade de Saúde Familiar Topázio em Coimbra, onde ainda continua actividade clínica, agora reduzida.

    Professor Associado Convidado da Universidade da Beira Interior, onde é regente das cadeiras de CSP I, II e III entre 2011 e 2017.

    Desde 2014 até 2017 foi Professor Adjunto Convidado da Coimbra Health Scholl lecionando Patologia Geral.   

    Membro da Academia Europeia de Professores em Medicina Geral e Familiar (EURACT) é orientador de Teses de Mestrado Integrado e de Mestrado Pré-Bolonha bem como de Doutoramento, na Universidade de Coimbra (2) e na Universidade da Beira Interior (6).

    É membro da Comissão de Ética da ARS do Centro.

    Tem vasta bibliografia publicada individualmente e em co-autoria em revistas nacionais e internacionais com “revisores-par” e indexadas (27 artigos).

    Desde março de 2017 é membro investigador do CEISUC, FEUC.

    Em Novembro de 2017 é eleito sócio correspondente da Academia Nacional de Medicina.

    Aguarda a marcação de Provas de Agregação a serem prestadas na Universidade da Beira Interior.

References

Schmidt AM. Highlighting diabetes mellitus: the epidemic continues. Arterioscler Thromb Vasc Biol. 2018;38(1):e1-e8.

International Diabetes Federation. IDF clinical practice recommendations for managing type 2 diabetes in primary care [homepage]. Brussels: IDF; 2017. Available from: https://d-net.idf.org/en/library/466-managing-type-2-diabetes-in-primary-care.html

Verma S, Hussain ME. Obesity and diabetes: an update. Diabetes Metab Syndr. 2017;11(1):73-9.

American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S13-28.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35(Suppl 1):S64-71.

Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European guidelines for obesity management in adults. Obes Facts. 2015;8(6):402-24.

Bray GA, Heisel WE, Afshin A, Jensen MD, Dietz WH, Long M, et al. The science of obesity management: an Endocrine Society Scientific statement. Endocr Rev. 2018;39(2):79-132.

Ng AC, Delgado V, Borlaug BA, Bax JJ. Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging. Nat Rev Cardiol. 2021;18(4):291-304.

Piché ME, Tchernof A, Després JP. Obesity phenotypes, diabetes, and cardiovascular diseases. Circ Res. 2020;126(11):1477-500.

Chobot A, Górowska-Kowolik K, Sokołowska M, Jarosz-Chobot P. Obesity and diabetes: not only a simple link between two epidemics. Diabetes Metab Res Rev. 2018;34(7):e3042.

Maggio CA, Pi-Sunyer FX. Obesity and type 2 diabetes. Endocrinol Metab Clin North Am. 2003;32(4):805-22.

Pulgaron ER, Delamater AM. Obesity and type 2 diabetes in children: epidemiology and treatment. Curr Diab Rep. 2014;14(8):508.

Administração Regional de Saúde do Centro. Perfil regional de saúde (Região Centro). Coimbra: ARS Centro; 2018. Available from: http://www.arscentro.min-saude.pt/wp-content/uploads/sites/6/2021/04/PeRS_Centro_2018.pdf

Malone JI, Hansen BC. Does obesity cause type 2 diabetes mellitus (T2DM)? Or is it the opposite? Pediatr Diabetes. 2019;20(1):5-9.

Pothuraju R, Sharma RK, Chagalamarri J, Jangra S, Kavadi PK. A systematic review of Gymnema sylvestre in obesity and diabetes management. J Sci Food Agric. 2014;94(5):834-40.

Jiang YY, Shui JC, Zhang BX, Chin JW, Yue RS. The potential roles of artemisinin and its derivatives in the treatment of type 2 diabetes mellitus. Front Pharmacol. 2020;11:585487.

Taylor R. Type 2 diabetes: etiology and reversibility. Diabetes Care. 2013;36(4):1047-55.

Duarte R, Melo M, Nunes JS, Melo PC, Raposo JF, Carvalho D. Recomendações nacionais da SPD para o tratamento da hiperglicemia na diabetes tipo 2: atualização 2018/19 com base na posição conjunta ADA/EASD [SPD national recommendations for the treatment of hyperglycemia in type 2 diabetes: update based in the ADA/EASD Joint Position Statement]. Rev Port Diabetes. 2018;13(4):154-80. Portuguese

Häring HU, Merker L, Seewaldt-Becker E, Weimer M, Meinicke T, Woerle HJ, et al. Empagliflozin as add-on to metformin plus sulfonylurea in patients with type 2 diabetes: a 24-week, randomized, double-blind, placebo-controlled trial. Diabetes Care. 2013;36(11):3396-404.

Dahiya L, Kaur R, Kumar R, Kumar M, Palta K. GLP-1 Receptor agonists in type 2 diabetes mellitus. Curr Diabetes Rev. 2020;16(4):279-92.

Cassis P, Locatelli M, Cerullo D, Corna D, Buelli S, Zanchi C, et al. SGLT2 inhibitor dapagliflozin limits podocyte damage in proteinuric nondiabetic nephropathy. JCI Insight. 2018;3(15):e98720.

Ni L, Yuan C, Chen G, Zhang C, Wu X. SGLT2i: beyond the glucose-lowering effect. Cardiovasc Diabetol. 2020;19(1):98.

Greco EV, Russo G, Giandalia A, Viazzi F, Pontremoli R, De Cosmo S. GLP-1 Receptor agonists and kidney protection. Medicina (Kaunas). 2019;55(6):233.

Meier JJ. GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2012;8(12):728-42.

Vilsbøll T, Christensen M, Junker AE, Knop FK, Gluud LL. Effects of glucagon-like peptide-1 receptor agonists on weight loss: systematic review and meta-analyses of randomised controlled trials. BMJ. 2012;344:d7771.

Brown E, Cuthbertson DJ, Wilding JP. Newer GLP-1 receptor agonists and obesity-diabetes. Peptides. 2018;100:61-7.

Scheen AJ. SGLT2 inhibitors as add-on therapy to metformin for people with type 2 diabetes: a review of placebo-controlled trials in Asian versus non-Asian patients. Diabetes Metab Syndr Obes. 2020;13:2765-79.

Heerspink HJ, Stefansson BV, Chertow GM, Correa-Rotter R, Greene T, Hou FF, et al. Rationale and protocol of the dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) randomized controlled trial. Nephrol Dial Transplant. 2020;35(2):274-82.

Chu C, Lu YP, Yin L, Hocher B. The SGLT2 inhibitor empagliflozin might be a new approach for the prevention of acute kidney injury. Kidney Blood Press Res. 2019;44(2):149-57.

American Diabetes Association. 6. Glycemic targets. Diabetes Care. 2017;40(Suppl 1):S48-56.

Crowley MJ, Holleman R, Klamerus ML, Bosworth HB, Edelman D, Heisler M. Factors associated with persistent poorly controlled diabetes mellitus: clues to improving management in patients with resistant poor control. Chronic Illn. 2014;10(4):291-302.

Bijelic R, Balaban J, Milicevic S, Sipka SU. The association of obesity and microvascular complications with glycemic control in patients with type 2 diabetes mellitus. Med Arch. 2020;74(1):14-8.

Ang GY. Age of onset of diabetes and all-cause mortality. World J Diabetes. 2020;11(4):95-9.

Azevedo C, Santiago L. Fiabilidade da Escala de Conhecimento da Diabetes em Portugal [Diabetes Knowledge Test feasibility in Portugal]. Acta Med Port. 2016;29(9):499-506. Portuguese

Aveiro M, Santiago LM, Ferreira PL, Simões JA. Estudo de fiabilidade da Escala de Capacidade de Controlo da Diabetes: versão breve [Fiability study of Diabetes Empowerment Scale: short version]. Acta Med Port. 2015;28(2):177-81. Portuguese

Santiago LM, Simões JA, Vale M, Faria E, Ferreira PL, Rosendo I. Auto perceção do desempenho da medicina centrada na pessoa em medicina geral e familiar: criação de um instrumento de medição [Self-awareness of performing patient-centered medicine in general practice/family medicine: development of a measurement scale]. Acta Med Port. 2020;33(6):407-14. Portuguese

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Published

2024-04-30

Issue

Vol. 40 No. 2 (2024): Revista Portuguesa de Medicina Geral e Familiar

Section

Original Research

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How to Cite

Terapêutica farmacológica com SGLT2i no controlo da diabetes mellitus tipo 2 e na obesidade associada. (2024). Portuguese Journal of Family Medicine and General Practice, 40(2), 148-56. https://doi.org/10.32385/rpmgf.v40i2.13647

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