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METFORMIN
(glucophage) (brand name: Metrivin) |
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Metrivin decreases endogenous glucose production
by the liver. New studies demonstrates that the mechanism
of action of metformin in liver involves insuline
receptor activation, followed by selective insuline
receptor substrate-2 activation, and increased glucose
uptake via increased GLUT-1 translocation.
Metrivin increase the number of muscle and adipocyte
insulin receptors and the attraction for the receptor.
It does not increase insulin secretion, it only increases
insulin sensitivity. Therefore, metformin is not associated
with causing hypoglycemia. This activity reduces insulin
levels by increasing the sensitivity of peripheral
tissues to the effects of insulin by rejuvenating
the response, and restoring glucose and insulin to
younger physiological levels that may cause weight
loss n inherited tendency to develop large numbers
of colorectal polyps that eventually become cancerous.
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Precose is an oral medication used to treat type 2
(noninsulin-dependent) diabetes when high blood sugar
levels cannot be controlled by diet alone. Precose
works by slowing the body's digestion of carbohydrates
so that blood sugar levels won't surge upward after
a meal. Precose may be taken alone or in combination
with certain other diabetes medications such as Diabinese,
Micronase, Glucophage, and Insulin.
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University of Alabama
at Birmingham, School of Medicine, Department of Medicine,
Birmingham, USA.
Because new drugs continue to be
developed, physicians treating patients with type
2 diabetes have a wide range of agents from which
to choose. The newest class, the thiazolidinediones
(TZDs), should be a mainstay of treatment for most
patients with type 2 diabetes, because these agents
reduce insulin resistance as well as improve glycemic
control. Patients with the insulin resistance syndrome
are at increased risk for developing cardiovascular
disease. However, decreasing insulin resistance with
TZD use may reduce the incidence of adverse cardiovascular
outcomes. TZDs also may reduce cardiovascular events
by acting directly on vascular smooth muscle cells
and by helping patients maintain normal hemoglobin
levels, without the risk of hypoglycemia. Furthermore,
prolonged glycemic control is expected with TZDs because
of their effects on beta-cell rejuvenation, a function
unique to this class. TZDs can be used safely in renally
impaired patients with diabetes, and hepatotoxicity
has not been a problem with second-generation TZDs,
making these agents both safe and effective in the
treatment of type 2 diabetes.
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Fovarosi Szent Imre Korhaz,
IV. Belgyogyaszat, Onallo Lipid Reszleg.
Diabetic dyslipidemia is mainly characterised
by hypertriglyceridaemia, low HDL-cholesterol level,
an increased small dense HDL concentration, i.e. by
atherogenic dyslipidemia. Dyslipidaemia occurs in
some two third of the type 2 diabetes cases. In the
treatment of dyslipidaemia it is essential to control
the diabetes, to reduce the intake of saturated fat
and supplement it with monounsatured fat ty acid or
complex carbohydrates. Based on the latest studies
diabetes is considered the same risk as coronary heart
disease and, therefore, diabetic dyslipidaemia should
be treated in the same aggressive way. According to
the simplified guidelines, after the diet--above 5.2
mmol/l cholesterol level--antilipaemic drugs, i.e.
statin should be administered in order to achieve
the primary goal of the therapy, namely the 2.6 mmol/l
LDL-cholesterol level. In patients with combined II/b
type hyperlipoproteinaemia statins are the drugs of
first choice, fibric acid derivates being only considered
in case of normal LDL-cholesterol level (< 3.4
mmol/l), if the HDL-cholesterol level is also low.
Fibrate therapy is the first choice in the isolated
hypertriglyceridaemia (> 2.3 mmol/l) as well as
in type V. hyperlipoproteinaemia. On the basis of
the guidelines far more patients with diabetes should
be treated with lipid lowering therapy than before.
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Service de Diabetologie,
Hopital Jean-Minjoz, 25030 Besancon Cedex.
Compliance is an old issue but crucial
in the management of chronic diseases. This is the
case in type 2 diabetes mellitus which requires several
drugs, either to treat diabetes or to prevent cardiovascular
complications. In this review, we discuss the relationships
between drug treatment regimens and treatment compliance
in type 2 diabetes and other chronic diseases. The
greater the number of daily drug intakes, the worst
the compliance, even if a single daily intake may
cause an increased risk of overdosing. Although the
number of tablets or treatments is less frequently
linked to compliance level than the number of daily
intake, polytherapy is generally associated with a
poor compliance. The consequences of a poor compliance
on the prognosis or the management of these diseases
are analysed based on cardiovascular studies. Even
if nearly no studies exist in type 2 diabetes, to
improve treatment compliance represents a major challenge
in these patients. Such improvement requires to preferentially
use once-a-day intake, but this is still difficult
with several oral anti-diabetics. Fixed combinations
such as the glibenclamide plus metformin combination,
cause a decrease in the number of daily tablets and
this permit a better compliance. Such approaches,
to be fully beneficial, should be part of a global
management of these type 2 diabetic patients, taking
into account all their difficulties to follow their
treatments, and based on a strong physician and patient
relationship.
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