Tip 2 Diyabette Fizyopatolojik Tedavi Yaklaşımı ve Pioglitazonun Yeri
Modern diyabet tedavi yaklaşımlarına rağmen diyabetik hastaların %50'den fazlasında glisemik kontrol yetersizdir. Yetersiz glisemik kontrolde hasta, hekim ve sağlık sistemi ile ilgili faktörlerin payı olmakla beraber hastalığın progresif bir karakterde olmasının da önemli etkisi vardır. Bu derlemede tip 2 diyabet tedavisinin ana ilkeleri ve insülin duyarlılaştırıcı olarak pioglitazonun yeri gözden geçirilmiştir
Physiopathological Treatment Approach and the Place of Pioglitazone in Type 2 Diabetes
Despite modern treatment approaches, glycemic control is inadequate in more than %50 of diabetic patients. In addition to the factors associated with the patient, physician and health system, the progressive character of the disease also plays an important role in inadequate glycemic control. This paper reviews the main principles in type 2 diabetes treatment and the place of pioglitazone as an insulin sensitizer
___
- 1.Defronzo RA. Banting Lecture. From the Triumvirate to the Ominous Octet: anew paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58:773–95.
- 2.DeFronzo RA, Eldor R, Abdul-Ghani M. Pathophysio-logic approach to therapy in patients with newly diag-nosed type 2 diabetes. Diabetes Care. 2013;36(Suppl 2):S127–38.
- 3.DeFronzo RA. Insulin resistance, lipotoxicity, type 2 di-abetes and atherosclerosis: the missing links. The Claude Bernard Lecture 2009. Diabetologia. 2010;53:1270–87.
- 4.Yki-Järvinen H. Thiazolidinediones. N Engl J Med. 2004;351:1106–18.
- 5.Eldor R, DeFronzo RA, Abdul-Ghani M. In vivo actions of peroxisome proliferator-activated receptors: glycemic control, insulin sensitivity, and insulin secretion. Diabe-tes Care. 2013;36(Suppl 2):S162–74.
- 6.Mazzone T, Meyer PM, Feinstein SB, Davidson MH, Kondos GT, D’Agostino RB Sr ve ark. Effect of piogli-tazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes: a randomized trial. JAMA. 2006;296(21):2572–81.
- 7.Nissen SE, Nicholls SJ, Wolski K, Nesto R, Kupfer S, Pe-rez A ve ark. Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized cont-rolled trial. JAMA. 2008;299(13):1561–73.
- 8.Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK ve ark. Secondary pre-vention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitA-zone Clinical Trial In macroVascular Events): a rando-mized controlled trial. Lancet. 2005;366(9493):1279–89.
- 9.Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucc-hi SE, Gorman M ve ark. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. N Engl J Med. 2016;374(14):1321–31.
- 10.Schernthaner G, Currie CJ, Schernthaner GH. Do we still need pioglitazone for the treatment of type 2 dia-betes? A risk-benefit critique in 2013. Diabetes Care. 2013;36(Suppl 2):S155–61.
- 11.Standards of Medical Care in Diabetes-2017: Summary of Revisions. Diabetes Care. 2017;40(Suppl 1):S4–S5.