Epistīmonika Chronika (Jan 2017)
Latest data on metabolic diseases: Diabetes Mellitus
Abstract
With such a high cost in money and human lives, diabetes mellitus (DM) is a major challenge for health care systems and an obstacle to sustainable economic growth. The pathophysiological disorders of diabetes include, besides the defect in pancreatic insulin secretion and insulin resistance in peripheral tissues (liver, muscle and adipose tissue), increased lipolysis, increased glucagon secretion, impaired secretion and action of incretin hormones, increased glucose resorption by the kidney and defects in the central nervous system. The therapeutic intervention must be timely and personalized. Lifestyle interventions (diet, exercise, smoking cessation) are the cornerstone of treatment. Treatment should begin with metformin unless there is a contraindication (eg renal failure) or intolerance (eg, gastrointestinal disorders). If HbA1c remains off target a second or a third treatment may be added, orally (glitazone, DPP-4 inhibitors, SGLT-2 inhibitors, sulfonylurea) or by injection (GLP-1 agonist or basal insulin). On failure to achieve glycemic target combinations of injectable treatments (combination of agonist GLP-1 with basal insulin, intensified insulin therapy or in some cases insulin mixtures) are recommended. New treatments (weekly administered GLP-1 analogs, combination of a basal insulin / GLP-1 in one injection, SGLT-2 inhibitors, long acting basal insulins) in combination with the old tried treatments (e.g. metformin, pioglitazone, inhibitors DPP-4) can contribute to human-centered and individualized management of patients with diabetes. The cardiovascular safety of antidiabetic treatment should be considered. There is a need for early diagnosis and treatment of glucose metabolism disorders during pregnancy (before 24 to 28 weeks of gestation) in women at high risk for developing gestational diabetes.
