View in PDF Number of views: The international guidelines for the management of type 2 diabetes mellitus have seen many changes over the peritoneal cancer fluid drainage decade.
They have moved from a strict glycemic control in all patients with diabetes to a more individualized approach of the diabetic patient.
These changes are the result of some trials which have demonstrated, for example, that in patients with long-standing type 2 diabetes a strict glycemic control may increase the risk of complications, such as hypoglycemia and cardiovascular events While glucose lowering prevents the appearance of microvascular complications, its impact is less significant on the cardiovascular and renal complications.
Peritoneal cancer fluid drainage most preferred oral antidiabetic drug is undoubtedly metformin.
There are six antidiabetic drug classes currently recommended by the American and European international societies, in addition to metformin: sodium-glucose cotransporter 2 SGLT2 inhibitors, glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, sulfonylureas, thiazolidinediones, and insulin.
SGLT2 inhibitors are a promising new class of antidiabetic drugs, that have entered very recently peritoneal cancer fluid drainage the diabetes therapeutic armamentarium.
These drugs enhance the urinary glucose excretion and decrease hyperglycemia, acting independently from insulin and being effective in all diabetic patients with preserved renal function. They have a favorable efficacy-to adverse event profile in type 2 diabetes patients with moderate-to-high risk.
Unfortunately, it does not have specific signs and symptoms, being associated with an aggressive evolution and a poor prognosis if left untreated. Their results suggest that PD-1 and PD-L1 could be potential biomarkers for targeted treatment in some patients diagnosed with diffuse large B-cell lymphoma. Malignant lymphomas of the head and neck may raise therapeutic difficulties.
peritoneal cancer fluid drainage These may be used as monotherapy or in combination with other antidiabetic agents. SGLT2 inhibitors have also pleiotropic effects, such as reducing body weight by Kg, decreasing the blood pressure both systolic and diastolicdecreasing plasma triglycerides, increasing HDL cholesterol, attenuating some factors associated with nonalcoholic steatohepatitis and nonalcoholic liver disease, improving the whole-body sodium balance peritoneal cancer fluid drainage volume status by stimulating the natriuresis, which leads further to a better endothelial function by reducing the vascular stiffness1.
Due to these effects, SGLT2 inhibitors are useful especially in obese patients with arterial hypertension. Regarding the glucose control, in a meta-analysis, the HbA1c reduction at weeks was higher in studies that included younger patients, with a shorter duration of diabetes and a higher body mass index, HbA1c and basal glucose4.
This is extremely important, especially for patients with type 2 diabetes and already established cardiovascular diseases, as they may benefit most from the treatment with SGLT2 inhibitors. The main side effects of SGLT2 inhibitors consist in the increased risk of genital infections up to four-fold in clinical trials.
Other side effects, more rarely, may be the risk of hypoglycemia, diabetic ketoacidosis, bone fractures with Canaglifozin.
This is an extremely rare, but life-threatening infection of the tissues around the perineal muscles, nerves, fat and blood vessels. In conclusion, SGLT2 inhibitors are the newest antidiabetic drugs class, with cardiovascular benefits in a selected population of type 2 diabetes patients.
There are ongoing studies with these antidiabetic agents expected to report their data in the near future.