Manejo da glicose sérica na diabetes tipo 2
A diabetes melito é uma doença crônica de prevalência crescente em todo o mundo. Para o controle glicêmico ideal no paciente diabético frequentemente é necessária a terapia farmacológica. Os hipoglicemiantes orais (HOs) podem ser usados isoladamente ou combinados a outros HOs ou insulina. O número de HOs cresceu consideravelmente na última década, o que representa um maior número de opções terapêuticas e um complexo processo de tomada de decisões pelos médicos. Este artigo de revisão tem o objetivo de auxiliar essas decisões. Revemos aqui o mecanismo de ação, a eficácia e os efeitos colaterais das diferentes classes de HOs (inibidores da alfa-glicosidase, biguanidas, secretagogos de insulina, sensibilizadores de insulina e inibidores da lipase intestinal) e discutimos suas recomendações de uso atuais.
Evidence-based guidelines for the treatment of type 2 diabetes mellitus focus on three areas: intensive lifestyle intervention that includes at least 150 minutes per week of physical activity, weight loss with an initial goal of 7 percent of baseline weight, and a low-fat, reduced-calorie diet; aggressive management of cardiovascular risk factors (i.e., hypertension, dyslipidemia, and microalbuminuria) with the use of aspirin, statins, and angiotensin-converting enzyme inhibitors; and normalization of blood glucose levels (hemoglobin A1C level less than 7 percent). Insulin resistance, decreased insulin secretion, and increased hepatic glucose output are the hallmarks of type 2 diabetes, and each class of medication targets one or more of these defects. Metformin, which decreases hepatic glucose output and sensitizes peripheral tissues to insulin, has been shown to decrease mortality rates in patients with type 2 diabetes and is considered a first-line agent. Other medications include sulfonylureas and nonsulfonylurea secretagogues, alpha glucosidase inhibitors, and thiazolidinediones. Insulin can be used acutely in patients newly diagnosed with type 2 diabetes to normalize blood glucose, or it can be added to a regimen of oral medication to improve glycemic control. Except in patients taking multiple insulin injections, home monitoring of blood glucose levels has questionable utility, especially in relatively well-controlled patients. Its use should be tailored to the needs of the individual patient.
