The role of novel antihyperglycaemic agents in the treatment of Type 2 diabetes - from glycaemic control to cardiovascular protection

Tatjana Žunić; Milojka Ponjavić

doi:10.5937/arhfarm70-26987

Tatjana Žunić Apoteka Beograd
Milojka Ponjavić Apoteka Beograd

DOI: https://doi.org/10.5937/arhfarm70-26987

Ključne reči: šećerna bolest tipa 2, kardioprotekcija, inhibitori natrijum-glukoza kotransportera 2 (SGLT2i), agonisti receptora za glukagonu-sličan peptid-1 (GLP-1R-agonisti)), ispitivanja kardiovaskularnih ishoda

Sažetak

Pojava novih antihiperglikemika ne samo da je donela veći izbor lekova koji se koriste za kontrolu glikemije, već je uvela promene i u drugim važnim aspektima terapije dijabetesa tipa 2 (T2DM) kao što su kardioprotekcija i renoprotekcija. Svi novi antihiperglikemici: inhibitori natrijum-glukoza kotransportera 2 (SGLT2i), agonisti receptora za glukagonu-sličan peptid-1 (GLP-1gonisti) i inhibitori dipeptidil peptidaze-4 (DPP-4i) bili su predmet ispitivanja multicentričnih prospektivnih placebo kontrolisanih studija u kojima su ispitivani kardiovaskularni ishodi (engl. Cardiovascular Outcome Trials - CVOT). Ipak, zapaženi kardioprotektivni efekti se ne smatraju svojstvom klase, posebno u grupi GLP-1 agonista, već su osobenost pojedinačnih predstavnika grupe. Na osnovu rezultata CVOT-a neki lekovi su dobili registrovanu indikaciju od Uprave za hranu i lekove (engl. Food and Drug Administration, FDA) za smanjenje rizika od velikih neželjenih kardiovaskularnih događaja kod odraslih sa šećernom bolešću tipa 2 i utvrđenim kardiovaskularnim bolestima (liraglutid, semiglutid, dulaglutid, kanagliflozin, empagliflozin, dapagliflozin). Kardiološka i dijabetološka društva priznala su rezultate CVOT-a na različite načine. Američka asocijacija za dijabetes (engl. American Diabetes Associations - ADA) i Evropska asocijacija za studije u dijabetesu (engl. European Association for the Study of Diabetes - EASD) još uvek smatraju metformin lekom prvog izbora, ali su uveli precizne kriterijume za korišćenje GLP-1 agoniste i SGLT2i kako u sekundarnoj, tako i u primarnoj prevenciji kardiovaskularnih (KV) bolesti. Kanadsko udruženje za dijabetes (Diabetes Canada) prepoznalo je upotrebu antihiperglikemika sa pokazanom KV koristi samo u sekundarnoj prevenciji. Evropsko društvo za kardiologiju (eng. European Society of Cardiology - ESC) dalo je prednost kardioprotektivnim efektima i odabralo GLP-1 agoniste i SGLT2i za terapiju prve linije kod novodijagnostikovanih T2DM pacijenta sa aterosklerotskom kardiovaskularnom bolešću (ASKVD). Nacionalni institut za izvrsnost u zdravstvu i nezi u Velikoj Britaniji (engl. National Institute for Health and Care Excellence - NICE) nije promenio predhodnu poziciju o primeni novih antihiperglikemijskih lekova samo za postizanje zadovoljavajuće kontrole glikemije bilo kao monoterapije kad je primena metformina kontraindikovana ili postoji intolerancija bilo kao dodatne terapije u dvojnim i trojnim kombinacijama antihiperglikemijskih lekova.

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Uloga novih antihiperglikemika u terapiji šećerne bolesti tipa 2 - od kontrole glikemije do kardiovaskularne zaštite

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