Tratamento do Diabetes Mellitus / Diabetes Mellitus' Treatment
Resumo
Introdução: Diversas são as complicações ocasionadas pelo diabetes mellitus quando não tratado adequadamente. Assim, o diagnóstico precoce para a rápida adoção do tratamento possibilita a obtenção do controle glicêmico e previne as complicações decorrentes do diabetes. Objetivo: Explicitar as linhas de cuidado disponíveis para auxiliar os pacientes diabéticos na obtenção do controle glicêmico. Material e Métodos: Revisão bibliográfica utilizando a base de dados PubMed, associada a uma consulta às recentes publicações oficiais de órgãos e instituições de saúde e a bulas de medicamentos. Sendo incluídas publicações em língua inglesa, portuguesa e francesa, publicadas até 2021. Resultados: A literatura relativa ao tratamento do diabetes é vasta e inclui tanto tratamentos não farmacológicos como tratamentos farmacológicos. O tratamento não farmacológico se baseia na mudança no estilo de vida, com adoção de hábitos alimentares saudáveis, prática de atividades físicas, cessação tabágica e controle do peso corpóreo, sendo indicados para todos os tipos de diabetes. As medidas farmacológicas se baseiam principalmente no uso de antidiabéticos de uso oral e na insulinoterapia, os quais devem ser introduzidos conforme o tipo do diabetes, o estágio atual da doença e quais antidiabéticos já foram utilizados, os parâmetros obtidos com o uso deles e quais as metas terapêuticas desejáveis a serem alcançadas. Conclusão: Os tratamentos disponíveis atualmente trouxeram bastante qualidade de vida aos diabéticos e novas pesquisas focam em implementar novas melhorias a esse tratamento.
Palavras-Chave: Diabetes Mellitus. Complicações do Diabetes. Estilo de Vida Saudável. Tratamento Farmacológico.
ABSTRACT
Introduction: Several complications are caused by diabetes mellitus when not properly treated. Thus, the early diagnosis for the rapid adoption of the treatment makes it possible to obtain glycemic control and prevent complications resulting from diabetes. Aim: To explicit the lines of care available to help the diabetic patients achieve glycemic control. Material and Methods: Bibliographic review using the PubMed database, associated with a consultation of recent official publications of health agencies and institutions and of drug inserts. Were included publications in English, Portuguese and French, published until 2021. Results: Literature relating to the treatment of diabetes is vast and includes both non-pharmacological and pharmacological treatments. Non-pharmacological treatment is based on a change in lifestyle, with adoption of healthy eating habits, physical activity, smoking cessation and body weight control, being indicated for all types of diabetes. Pharmacological treatments are mainly based on the use of oral antidiabetics and insulin therapy, which should be introduced according to the type of diabetes, the current stage of the disease and which antidiabetics have already been used, the parameters obtained with their use and which are the desirable therapeutic goals to be achieved. Conclusion: Treatments currently available have brought more quality of life to diabetics and new research is focused on implementing new improvements to this treatment.
Key-Words: Diabetes Mellitus. Diabetes Complications. Healthy Lifestyle. Drug Therapy.
Palavras-chave
Referências
ADA – American Diabetes Association. Standards of Medical Care in diabetes – 2020. Diabetes Care, v. 43, Supl. 1, p. S1-S212, Jan. 2020.
ADVANCE – The ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. The New England Journal of Medicine, v. 358, n. 24, p. 2560-2572, June 2008. https://doi.org/10.1056/NEJMoa0802987.
ANDERSEN, A. et al. Glucagon-like peptide 1 in health and disease. Nature Reviews Endocrinology, v. 14, n. 7, p. 390-403, July 2018. https://doi.org/10.1038/s41574-018-0016-2.
APOVIAN, C. M.; OKEMAH, J.; O’NEIL, P. M. Body Weight Considerations in the Management of Type 2 Diabetes. Advances in Therapy, v. 36, n. 1, p. 44-58, Jan. 2018. https://doi.org/10.1007/s12325-018-0824-8.
ASCENSO, R. Impacto do diabetes precoce sobre a função vascular da musculatura esquelética. 2021. Tese (Doutorado em Farmacologia) – Programa de Pós-Graduação em Farmacologia, Universidade Federal de Santa Catarina, Florianópolis, 2021.
ASHCROFT, S. J. H.; ASHCROFT, F. M. (1992). The sulfonylurea receptor. Biochimica et Biophysica Acta (BBA) - Molecular Cell Research, v. 1175, n. 1, p. 45-59, Dec. 1992. https://doi.org/10.1016/0167-4889(92)90008-Y.
ATKINSON, M. A.; EISENBARTH, G. S.; MICHELS, A. W. Type 1 diabetes. Lancet, v. 383, n. 9911, p. 69-82, Jan. 2014. https://doi.org/10.1016/S0140-6736(13)60591-7.
BALFOUR, J. A.; MCTAVISH, D. Acarbose: An Update of its Pharmacology and Therapeutic Use in Diabetes Mellitus. Drugs, v. 46, n. 6, p. 1025-1054, Dec. 1993. https://doi.org/10.2165/00003495-199346060-00007.
BANTING, F. G. et al. The effect produced on diabetes by extracts of pancreas. Transactions of the Association of American Physicians, p. 337-347, 1922.
BOJANOWSKA, E. Physiology and pathophysiology of glucagon-like peptide-1 (GLP-1): The role of GLP-1 in the pathogenesis of diabetes mellitus, obesity, and stress. Medical Science Monitor, v. 11, n. 8, p. RA271- RA278, Aug. 2005.
BOULÉ, N. G. et al. Effects of Exercise on Glycemic Control and Body Mass in Type 2 Diabetes Mellitus. JAMA, v. 286, n. 10, p. 1218-1227, Sept. 2001. https://doi.org/10.1001/jama.286.10.1218.
BRASIL, Ministério da Saúde, Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Cadernos de Atenção Básica n. 36 - Diabetes mellitus: estratégias para o cuidado da pessoa com doença crônica. 1. ed. Brasília: Ministério da Saúde, 2013. 160 p.
______. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Relação Nacional de Medicamentos Essenciais – RENAME 2020. Brasília: Ministério da Saúde, 2020. 217 p.
BUCHANAN, T. A. et al. Response of pancreatic β-cells to improved insulin sensitivity in women at high risk for type 2 diabetes. Diabetes, v. 49, n. 5, p. 782-788, May 2000. https://doi.org/10.2337/diabetes.49.5.782.
CAMPBELL, J. E.; DRUCKER, D. J. Islet α cells and glucagon—critical regulators of energy homeostasis. Nature Reviews Endocrinology, v. 11, n. 6, p. 329-338, June 2015. https://doi.org/10.1038/nrendo.2015.51.
CARVALHO, R. C. et al. Association between intra-hospital uncontrolled glycemia and health outcomes in patients with diabetes: A systematic review of observational studies. Current Diabetes Reviews, v.17, n. 3, p. 304-316, 2021. https://doi.org/10.2174/1573399816666200130093523.
CODELLA, R.; TERRUZZI, I.; LUZI, L. Why should people with type 1 diabetes exercise regularly? Acta Diabetologica, v. 54, n. 7, p. 615-630, July 2017. https://doi.org/10.1007/s00592-017-0978-x.
Comissão Nacional de Incorporação de Tecnologias no SUS – CONITEC. Ministério da Saúde. Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde. Departamento de Gestão e Incorporação de Tecnologias e Inovação em Saúde. Empagliflozina e dapagliflozina para o tratamento de diabetes mellitus tipo 2: relatório de recomendação n. 524. Brasília: Ministério da Saúde, 2020.
DCCT RESEARCH GROUP – The Diabetes Control and Complications Trial. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. The New England Journal of Medicine, v. 329, n. 14, p. 977-986, Sept. 1993. https://doi.org/10.1056/nejm199309303291401.
______. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial. The Journal of Pediatrics, v. 125, n. 2, p. 177-188, Aug. 1994. https://doi.org/10.1016/s0022-3476(94)70190-3.
DONNELLY, R. et al. ABC of arterial and venous disease: vascular complications of diabetes. The BMJ, v. 320, n. 7241, p. 1062-1066, Apr. 2000. https://doi.org/10.1136/bmj.320.7241.1062.
DORNHORST, A. Insulinotropic meglitinide analogues. The Lancet, v. 358, n. 9294, p. 1709-1716, Nov. 2001. https://doi.org/10.1016/S0140-6736(01)06715-0.
DRUCKER, D. J. Enhancing Incretin Action for the Treatment of Type 2 Diabetes. Diabetes Care, v. 26, n. 10, p. 2929-2940, Oct. 2003. https://doi.org/10.2337/diacare.26.10.2929.
EDELMAN, S.; MAIER, H.; WILHELM, K. Pramlintide in the Treatment of Diabetes Mellitus. BioDrugs, v. 22, n. 6, p. 375-386, Nov./Dec. 2008. https://doi.org/10.2165/0063030-200822060-00004.
FARILLA, L. et al. Glucagon-Like Peptide-1 Promotes Islet Cell Growth and Inhibits Apoptosis in Zucker Diabetic Rats, Endocrinology, v. 143, n. 11, p. 4397-4408, Nov. 2002. https://doi.org/10.1210/en.2002-220405.
FLORY, J.; LIPSKA, K. Metformin in 2019. JAMA, v. 321, n. 19, p. 1926-1927, May 2019. https://doi.org/10.1001/jama.2019.3805.
FORETZ, M. et al. Metformin: From Mechanisms of Action to Therapies. Cell Metabolism, v. 20, n. 6, p. 953-966, Dec. 2014. https://doi.org/10.1016/j.cmet.2014.09.018.
FRÜHBECK, G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nature Reviews Endocrinology, v. 11, n. 8, p. 465-477, Aug. 2015. https://doi.org/10.1038/nrendo.2015.84.
GÆDE, P. et al. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes. The New England Journal of Medicine, v. 348, n. 5, p. 383-393, Jan. 2003. https://doi.org/10.1056/NEJMoa021778.
GALE, E. A. M. Lessons from the glitazones: a story of drug development. The Lancet, v. 357, n. 9271, p. 1870-1875, June 2001. https://doi.org/10.1016/S0140-6736(00)04960-6.
GONG, Q. et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. The Lancet Diabetes & Endocrinology, v. 7, n. 6, p. 452-461, June 2019. http://dx.doi.org/10.1016/S2213-8587(19)30093-2.
HADAEGH, F. et al. High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study. BMC Public Health, v. 8, n. 1, p. 1-7, May 2008. https://doi.org/10.1186/1471-2458-8-176.
HÆDERSDAL, S. et al. The Role of Glucagon in the Pathophysiology and Treatment of Type 2 Diabetes. Mayo Clinic Proceedings, v. 93, n. 2, p. 217-239, Feb. 2018. https://doi.org/10.1016/j.mayocp.2017.12.003.
HOSTALEK, U.; GWILT, M.; HILDEMANN, S. Therapeutic Use of Metformin in Prediabetes and Diabetes Prevention. Drugs, v. 75, n. 10, p. 1071-1094, July 2015. https://doi.org/10.1007/s40265-015-0416-8.
IDF – International Diabetes Federation. IDF Diabetes Atlas Ninth edition 2019, 9th edn. Brussels, Belgium: IDF, 2019. Disponível em: .
KALRA, S.; MADHU, S. V.; BAJAJ, S. Sulfonylureas: Assets in the past, present and future. Indian Journal of Endocrinology and Metabolism, v. 19, n. 3, p. 314-316, May/Jun. 2015. https://doi.org/10.4103/2230-8210.149925.
KULINA, G. R.; RAYFIELD, E. J. The role of glucagon in the pathophysiology and management of diabetes. Endocrine Practice, v. 22, n. 5, p. 612-621, May 2016. https://doi.org/10.4158/ep15984.ra.
LEBOVITZ, H. E. Alpha-Glucosidase Inhibitors. Endocrinology and Metabolism Clinics of North America, v. 26, n. 3, p. 539-551, Sept. 1997. https://doi.org/10.1016/S0889-8529(05)70266-8.
LEVETAN, C. Oral antidiabetic agents in type 2 diabetes, Current Medical Research and Opinion, v. 23, n. 4, p. 945-952, Apr. 2007. https://doi.org/10.1185/030079907X178766.
LV, W. et al. Mechanisms and Characteristics of Sulfonylureas and Glinides. Current Topics in Medicinal Chemistry, v. 20, n. 1, p. 37-56, 2020. https://doi.org/10.2174/1568026620666191224141617.
MARUTHUR, N. M. et al. Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes. Annals of Internal Medicine, v. 164, n. 11, p. 740-751, June 2016. https://doi.org/10.7326/m15-2650.
MEIER, J. J. GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus. Nature Reviews Endocrinology, v. 8, n. 12, p. 728-742, Dec. 2012. https://doi.org/10.1038/nrendo.2012.140.
MOZAFFARIAN, D. Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review. Circulation, v. 133, n. 2, p. 187-225, Jan. 2016. https://doi.org/10.1161/circulationaha.115.018585.
Ministério da Saúde – MS. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Portaria nº 11, de 13 de março de 2017. Torna pública a decisão de incorporar caneta para injeção de insulina humana NPH e insulina humana regular no âmbito do Sistema Único de Saúde - SUS. 2017.
______. Secretaria de Ciência, Tecnologia e Insumos Estratégicos. Departamento de Assistência Farmacêutica e Insumos Estratégicos. Nota técnica nº 71/2020-CGAFB/DAF/SCTIE/MS. Atualização sobre distribuição e critérios para dispensação das canetas aplicadoras de insulina humana NPH (Insulina Humana NPH 100 UI/ml, tubete de 3 ml), insulina humana regular (Insulina Humana Regular 100 UI/ml, tubete de 3 ml) e agulhas de aço inoxidável para caneta aplicadora. 2020.
MUSKIET, M. H. A. et al. GLP-1 and the kidney: from physiology to pharmacology and outcomes in diabetes. Nature Reviews Nephrology, v. 13, n. 10, p. 605-628, Oct. 2017. https://doi.org/10.1038/nrneph.2017.123.
NATHAN, D. M. et al. Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes Mellitus. The New England Journal of Medicine, v. 348, n. 23, p. 2294-2303, June 2003. https://doi.org/10.1056/nejmoa022314.
______. et al. Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes. The New England Journal of Medicine, v. 353, n. 25, p. 2643-2653, Dec. 2005. https://doi.org/10.1056/nejmoa052187.
______. et al. Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, v. 32, n. 1, p. 193-203, Jan. 2009. https://doi.org/10.2337/dc08-9025.
NEAL, B. et al. Efficacy and Safety of Canagliflozin, an Inhibitor of Sodium–Glucose Cotransporter 2, When Used in Conjunction With Insulin Therapy in Patients With Type 2 Diabetes. Diabetes Care, v. 38, n. 3, p. 403-411, Mar. 2015. https://doi.org/10.2337/dc14-1237.
NELSON, K. M.; BOYKO, E. J.; KOEPSELL, T. All-Cause Mortality Risk among a National Sample of Individuals with Diabetes. Diabetes Care, v. 33, n. 11, p. 2360-2364, Nov. 2010. https://doi.org/10.2337/dc10-0846.
PANTEN, U.; SCHWANSTECHER, M.; SCHWANSTECHER, C. Sulfonylurea receptors and mechanism of sulfonylurea action. Experimental and Clinical Endocrinology & Diabetes, v. 104, n. 01, p. 1-9, Jan./Feb. 1996. https://doi.org/10.1055/s-0029-1211414.
PHUNG, O. J. et al. Effect of Noninsulin Antidiabetic Drugs Added to Metformin Therapy on Glycemic Control, Weight Gain, and Hypoglycemia in Type 2 Diabetes. JAMA, v. 303, n. 14, p. 1410-1408, Apr. 2010. https://doi.org/10.1001/jama.2010.405.
PLOMGAARD, P.; WEIGERT, C. Do diabetes and obesity affect the metabolic response to exercise? Current Opinion in Clinical Nutrition and Metabolic Care, v. 20, n. 4, p. 294-299, July 2017. https://doi.org/10.1097/MCO.0000000000000379.
PLUTZKY, J. Inflammation in Atherosclerosis and Diabetes Mellitus. Reviews in Endocrine & Metabolic Disorders, v. 5, n. 3, p. 255-259, Aug. 2004. https://doi.org/10.1023/B:REMD.0000032414.17672.5c.
RADERMECKER, R. P. Place des insulinosécrétagogues dans le traitement du diabète de type 2. Revue Medicale de Liege, v. 60, n. 5-6, p. 402-408, mai/juin 2005.
RAHMOUNE, H. et al. Glucose Transporters in Human Renal Proximal Tubular Cells Isolated From the Urine of Patients With Non–Insulin-Dependent Diabetes. Diabetes, v. 54, n. 12, p. 3427-3434, Dec. 2005. https://doi.org/10.2337/diabetes.54.12.3427.
RAMRACHEYA, R. D. et al. PYY-Dependent Restoration of Impaired Insulin and Glucagon Secretion in Type 2 Diabetes following Roux-En-Y Gastric Bypass Surgery. Cell Reports, v. 15, n. 5, p. 944-950, May 2016. https://doi.org/10.1016/j.celrep.2016.03.091.
REGENSTEINER, J. G.; BAUER, T. A.; REUSCH, J. E. B. Rosiglitazone Improves Exercise Capacity in Individuals With Type 2 Diabetes. Diabetes Care, v. 28, n. 12, p. 2877-2883, Dec. 2005. https://doi.org/10.2337/diacare.28.12.2877.
RIDLER, C. Roux-en-Y rescues islet function via PYY. Nature Reviews Endocrinology, v. 12, n. 7, p. 373-373, July 2016. https://doi.org/10.1038/nrendo.2016.72.
ROSENSTOCK, J. et al. Improved Glucose Control With Weight Loss, Lower Insulin Doses, and No Increased Hypoglycemia With Empagliflozin Added to Titrated Multiple Daily Injections of Insulin in Obese Inadequately Controlled Type 2 Diabetes. Diabetes Care, v. 37, n. 7, p. 1815-1823, July 2014. https://doi.org/10.2337/dc13-3055.
______. et al. Impact of empagliflozin added on to basal insulin in type 2 diabetes inadequately controlled on basal insulin: a 78‐week randomized, double‐blind, placebo‐controlled trial. Diabetes, Obesity and Metabolism, v. 17, n. 10, p. 936-948, Oct. 2015. https://doi.org/10.1111/dom.12503.
Sociedade Brasileira de Diabetes – SBD. Diretrizes da Sociedade Brasileira de Diabetes 2019-2020. 1. ed. São Paulo: Clannad Editora Científica, 2020. 489 p.
SCHEEN, A. J. Le médicament du mois: Dapagliflozine (Forxiga®) Inhibiteur des cotransporteurs rénaux SGLT2, nouvel agent anti-hyperglycémiant dans le diabète de type 2. Revue Medicale de Liege, v. 71, n. 10, p. 463-469, oct. 2016.
SERVIER. DIAMICRON® MR (gliclazida): comprimidos de liberação prolongada. Farmacêutico Responsável Patrícia Kasesky de Avellar. Rio de Janeiro: Laboratórios Servier do Brasil Ltda, 2016. Bula de medicamento (8 p.).
SHIGETO, M. et al. A role of PLC/PKC-dependent pathway in GLP-1-stimulated insulin secretion. Journal of Molecular Medicine, v. 95, n. 4, p. 361-368, Apr. 2017. https://doi.org/10.1007/s00109-017-1508-6.
STEINER, K. E.; LIEN, E. L. 6 Hypoglycaemic Agents Which Do Not Release Insulin. Progress in Medicinal Chemistry, v. 24, p. 209-248, 1987. https://doi.org/10.1016/S0079-6468(08)70423-5.
TAHRANI, A. A.; BARNETT, A. H.; BAILEY, C. J. Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus. Nature Reviews Endocrinology, v. 12, n. 10, p. 566-592, Oct. 2016. https://doi.org/10.1038/nrendo.2016.86.
TORRALBA, F. et al. HEART, TIMI, and GRACE Scores for Prediction of 30-Day Major Adverse Cardiovascular Events in the Era of High-Sensitivity Troponin. Arquivos Brasileiros de Cardiologia, São Paulo, v. 114, n. 5, p. 795-802, May 2020. https://doi.org/10.36660/abc.20190206.
TRIPATHI, B. K.; SRIVASTAVA, A. K. Diabetes mellitus: Complications and therapeutics. Medical Science Monitor, v. 12, n. 7, p. RA130-RA147, July 2006.
WANG, P. et al. Diabetes mellitus—advances and challenges in human β-cell proliferation. Nature Reviews Endocrinology, v. 11, n. 4, p. 201-212, Apr. 2015. https://doi.org/10.1038/nrendo.2015.9.
WILDING, J. P. H. et al. Dapagliflozin in patients with type 2 diabetes receiving high doses of insulin: efficacy and safety over 2 years. Diabetes, Obesity and Metabolism, v. 16, n. 2, p. 124-136, Feb. 2014. https://doi.org/10.1111/dom.12187.
______. et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine, v. 384, p. 989-1002, Mar. 2021. https://doi.org/10.1056/NEJMoa2032183.
WILLI, C. et al. Active Smoking and the Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA, v. 298, n. 22, p. 2654-2664, Dec. 2007. https://doi.org/10.1001/jama.298.22.2654.
WOO, V. C. et al. Considerations for Initiating a Sodium-Glucose Co-Transporter 2 Inhibitor in Individuals with Type 2 Diabetes Using Insulin. Canadian Journal of Diabetes, v. 42, n. 1, p. 88-93, Feb. 2018. https://doi.org/10.1016/j.jcjd.2017.01.009.
YEH, H. C. et al. Smoking, Smoking Cessation, and Risk for Type 2 Diabetes Mellitus: A Cohort Study. Annals of Internal Medicine, v. 152, n. 1, p. 10-17, Jan. 2010. https://doi.org/10.7326/0003-4819-152-1-201001050-00005.
DOI: http://dx.doi.org/10.12819/rsf.2022.9.1.5
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