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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
91

Estratégia de operações: estudos de caso em revendas de gás LP em cidades do nordeste do Brasil

Muniz, Luiz Fabiano de Oliveira 26 September 2014 (has links)
Made available in DSpace on 2016-06-02T19:52:09Z (GMT). No. of bitstreams: 1 6536.pdf: 5744234 bytes, checksum: 3254e778ef288a6a42f50e87dc293065 (MD5) Previous issue date: 2014-09-26 / One of the key factors for a successful resale of gas has, besides the relevant issues to any type of business it is maintaining a strategy aligned operations in which the Company Distributor maintains trade relations. Besides helping in the success of business strategies Distributor, resale becomes an agent of accomplishment and execution of the sale, despite its absolutely independent management. The goal of any organization, regardless of what it proposes to accomplish is to survive. But to enable such condition is very critical to have clearly defined what your positioning, as well as necessary for its operation presents a position to deliver the requirements sought by their customers attributes. In other words, this means that for an organization to be successful, it must, among other factors, the establishment of a goal to be achieved, the identification and understanding of the characteristics of competitors, differential required for operation and development of capabilities and new differential. This work aimed to study how dealers three gas companies, in northeastern Brazil, faithful to the same distributor develop their strategies and operations which the results obtained by them. To achieve this goal, first a literature able to support the development of a theoretical framework in order to develop a thorough knowledge of the subject studied and to establish a conceptual framework focused on field research, which was composed of studies was conducted case of exploratory and qualitative performed in each of the companies analyzed. After the description of the individual case studies, a cross was made of the results obtained, which were compared to identify similar characteristics and differences between companies. It was found that among the retailers studied, those with the highest level of integration with the distributor have trained to generate the expected results for its owners operating their function. In addition, issues such as defining strategic priorities, better level of service, investments and consistent development of decision areas become more favorable than that which does not share the same degree of integration. / Um dos fatores fundamentais para que uma revenda de gás tenha sucesso, além das questões pertinentes a qualquer tipo de negócio, é ela manter uma estratégia de operações alinhada à Companhia Distribuidora na qual mantem relações comerciais. Além de auxiliar no êxito das estratégias de negócio da Distribuidora, a revenda se torna um agente de realização e execução da venda, apesar de ter sua gestão absolutamente independente. O objetivo de qualquer organização, independente daquilo que se proponha realizar, é sobreviver. Porém, para que possa garantir essa condição, é fundamental ter muito claramente definido qual seu posicionamento, assim como os atributos necessários para que sua operação apresente condições de entregar os requisitos buscados por seus clientes. Em outras palavras, isso quer dizer que, para que uma organização seja bem sucedida é necessário, entre outros fatores, do estabelecimento de um objetivo a ser alcançado, da identificação e da compreensão das características dos concorrentes, dos diferenciais necessários para a operação e do desenvolvimento de capacitações e novos diferenciais. Este trabalho propôs-se a estudar o modo como três empresas revendedoras de gás, da região Nordeste do Brasil, fiéis ao mesmo distribuidor desenvolvem suas estratégias de operações e quais os resultados obtidos por meio delas. Para alcançar esse objetivo, primeiramente foi realizada uma pesquisa bibliográfica capaz de fundamentar a elaboração de um referencial teórico, com o intuito de desenvolver um conhecimento aprofundado sobre o tema estudado e de estabelecer uma estrutura conceitual voltada à pesquisa de campo, a qual foi composta por estudos de caso de caráter exploratório e qualitativo realizados em cada uma das empresas analisadas. Após a descrição dos estudos de caso individuais, foi feito um cruzamento dos resultados obtidos, os quais foram comparados a fim de identificar características similares e diferenças entre as empresas. Constatou-se que, entre as revendas estudadas, aquelas com o maior nível de integração com a distribuidora apresentam sua função operação capacitadas para gerar os resultados esperados por seus proprietários. Além disso, questões como definição das prioridades estratégicas, melhor nível de prestação de serviço, investimentos e desenvolvimento consistente de áreas de decisão se tornam mais favoráveis do que àquela que não compartilha do mesmo grau de integração.
92

Excelência logística e trabalho em equipe: estudo de caso em uma empresa distribuidora da GLP / Logistics excellence and teamwork: a case study in a LPG distribution company

Matheus de Aguiar Sillos 09 September 2011 (has links)
O presente trabalho objetiva identificar e analisar as dimensões de excelência logística, desenvolvidas como forma de se obter vantagens competitivas, buscando analisar a influência do trabalho organizado em equipes na excelência logística de uma organização do mercado de Gás Liquefeito de Petróleo. O trabalho foi realizado através de uma revisão bibliográfica sobre os temas excelência logística nas organizações e trabalho organizado em equipes. Como metodologia foi proposto um construto teórico de excelência logística e trabalho em equipe, realizado através de uma revisão bibliográfica sobre os temas, com a apresentação de um estudo de caso em uma empresa líder do mercado em que atua, de forma a ilustrar a aplicação dos conceitos propostos. Como resultado, o trabalho conclui que a organização do trabalho em equipes se mostra grande apoiadora das práticas de excelência logística nessa organização, integrando e possibilitando o desenvolvimento das diferentes dimensões de excelência logística. / This paper aims to identify and analyze the dimensions of logistics excellence, developed as a way to gain competitive advantage, seeking to analyze the influence of teamwork in the logistics excellence of a Liquefied Petroleum Gas organization. The study was conducted through a literature review on the issues logistics excellence in organizations and teamwork. The methodology has been proposed a theoretical construct of logistics excellence and teamwork, accomplished through a literature review on the issues, with the presentation of a case study in a leading company in the market it operates, in order to illustrate the application of concepts proposed. As a result, the paper concludes that the organization of teamwork is a strong supporter of logistics best practices in this organization, integrating and enabling the development of the different dimensions of logistics excellence.
93

Escolhas estratégicas na decisão sobre canais de distribuição em commodities: um estudo de caso no segmento de gás liquefeito de petróleo (GLP) / Strategic choices in decision making on distribution channels in commodities: a case study in liquefied petroleum gas (lpg) segment

Fernando Shigueo Omoto Bittar 20 September 2013 (has links)
O setor de Gás Liquefeito de Petróleo (GLP), produto considerado de primeira necessidade para a população brasileira, está inserido em um ambiente altamente competitivo devido a poucas barreiras de entrada, ao aumento da atratividade e à baixa diferenciação do produto. Nesse cenário, os sistemas de distribuição propiciam um componente de grande importância no que se refere à diferenciação e ao desenvolvimento de vantagens competitivas no varejo. Assim, o presente estudo tem como objetivo geral analisar os principais aspectos a serem levados em consideração na tomada de decisão sobre os canais de distribuição no segmento domiciliar de GLP, referente ao primeiro elo da cadeia (distribuidora para revenda de GLP). Como objetivos específicos, se destacam a verificação da relevância das variáveis encontradas na literatura para o mercado domiciliar de GLP e a verificação de uma tendência para o setor. Para isso, serão abordados referenciais teóricos sob a ótica da Organização Industrial (OI), da Nova Economia Institucional (NEI) e de Canais de Marketing. Buscando atingir os objetivos propostos, além da revisão teórica, foi realizado um levantamento histórico sobre o GLP e as principais distribuidoras brasileiras, o qual trouxe à tona fatos políticos e econômicos que influenciam até hoje as decisões dos agentes econômicos do setor. O método utilizado foi uma pesquisa qualitativa, por meio de um estudo de caso na maior empresa brasileira de distribuição de GLP, a Cia. Ultragaz S/A. Foram desenvolvidos e aplicados questionários semiestruturados, por meio de entrevistas com os executivos da alta direção da empresa e com um executivo da direção do Sindicato Nacional das Empresas Distribuidoras do Gás Liquefeito do Petróleo (SINDIGÁS), trazendo assim uma visão mais global do segmento. Após a aplicação do estudo de caso, foram encontrados resultados relevantes para a academia, dos quais pode ser citada a constatação de que não existe uma relação direta entre as variáreis \"ativos específicos\" e \"incerteza interna/comportamental\" com a escolha dos canais de distribuição. Outros resultados importantes provindos da análise dos dados foram: a ordenação dos fatores que determinam a escolha dos canais indiretos e a influência das relações de poder na tomada de decisão em canais de distribuição. Por fim, analisando a tendência do setor, o mercado de GLP não deve findar nos próximos 50 anos e, se isso ocorresse, as empresas atuais buscariam novos mercados fora do setor de energia. Dessa forma, apesar das limitações, as quais serão apresentadas ao final da presente dissertação, muitos estudos acadêmicos ainda podem ser desenvolvidos dentro desse setor de expressiva relevância econômica e social para o País. / The Liquefied Petroleum Gas (LPG) sector, a product deemed basic needs for the Brazilian population is placed in a highly competitive environment due to a few barriers to entry, the increase in attractiveness and low product differentiation. In this scenario, the distribution systems provide a component of great importance regarding differentiation and development of competitive advantages in the retail market. Thus, this study aims to conduct an analysis on the main aspects to be taken into consideration when deciding on the distribution channels in the LPG household segment, referring to the first link in the chain (LPG distributor for dealer). The specific objectives are: verifying the relevance of the variables found in the literature for the LPG residential market and verifying the trend for the sector. For this purpose theoretical perspectives will be discussed using Industrial Organization, New Institutional Economics and Marketing Channels. In order to reach the proposed aims, a survey was conducted on the LPG history and major Brazilian distributors besides the theoretical review, which brought up political and economic facts that influence present decisions of economic agents in the industry. The method used was a qualitative research by means of a case study in the largest Brazilian LPG distributor, Cia. Ultragaz S/A. Semi-structured questionnaires were developed and applied by means of interviews with executives from company top management and with an executive director of the National Association of Liquefied Petroleum Gas Distributors (SINDIGÁS), bringing out a global view of the segment. After the application of the case study, relevant results were found to the academy, which may be due to the fact that there is not a direct relationship between the variables \"specific assets\" and \"internal behavioral/uncertainty\" with the choice of the distribution channels. Other important results obtained from the data analysis were: the hierarchical ordering of factors that determine the choice of indirect channels and the influence of power relations in decision making on distribution channels. Finally, by analyzing the industry´s trends, the LPG market should not end in the next 50 years and, if it that happened, current companies would look for new markets outside the energy sector. Thus, despite the limitations, which will be presented at the end of this study, many academic studies can still be developed in a sector which presents economic and social relevancy for the country.
94

Implication du transporteur intestinal GLUT2 dans l'absorption des sucres et la fonction entéroendocrine / Intestinal GLUT2 role in sugar absorption and enteroendocrine function

Schmitt, Charlotte 25 November 2016 (has links)
L'épithélium intestinal, en constant renouvellement, assure de nombreuses fonctions vitales comme l'absorption des nutriments et le maintien d'une barrière entre le milieu extérieur et l'organisme. L'absorption intestinale des sucres est assurée par de nombreux transporteurs au niveau de l'intestin proximal. Parmi eux, GLUT2, localisé dans les entérocytes et les cellules endocrines de l'intestin, transporte le glucose, le fructose et le galactose. Les cellules L entéroendocrines produisent le GLP-1, un puissant stimulateur de la sécrétion d'insuline en réponse au glucose. L'objectif de ma thèse a été d'élucider le rôle de GLUT2 intestinal dans l'absorption des sucres et la fonction entéroendocrine grâce à l'étude d'un modèle murin spécifiquement invalidé pour ce transporteur dans les cellules épithéliales intestinales. La délétion intestinale de GLUT2 entraîne une malabsorption intestinale modérée des sucres associée à une distribution retardée du glucose aux tissus périphériques. Le retard spatial et temporel de l'absorption des sucres provoque une dysbiose intestinale au profit de bactéries ayant un rôle protecteur de l'homéostasie intestinale. De façon surprenante, l'invalidation de GLUT2 intestinal s'accompagne d'une chute de la densité de cellules L entéroendocrines, sans modification des niveaux plasmatiques de GLP-1. Cette étude met en exergue le rôle primordial de GLUT2 intestinal dans l'absorption des sucres et la fonction endocrine de l'intestin. Elle permet d'envisager le criblage de molécules capables d'inhiber l'activité de GLUT2 intestinal, pour atténuer la prise de poids et limiter les perturbations métaboliques induites par des régimes riches en sucres. / The constantly renewing intestinal epithelium handles various essential functions including nutrient absorption and persistence of a barrier between our internal and external environments. Several transporters mediate sugar absorption in the proximal intestine. Among them, GLUT2, a very efficient glucose, fructose and galactose transporter and receptor, is located at the membranes of enterocytes and enteroendocrine cells. The enteroendocrine L-cells produce GLP-1, a strong activator of glucose-induced insulin secretion. This thesis aimed to further decipher the role of intestinal GLUT2 in sugar absorption and enteroendocrine cell function. To address this question, mice lacking GLUT2 specifically in intestinal epithelial cells have been generated and studied. Intestinal GLUT2 invalidation alters intestinal glucose absorption and delays glucose biodistribution to peripheral tissues. This spatial and temporal sugar absorption delay provokes intestinal dysbiosis, favoring gut microbiota having a protective impact on gut homeostasis. Surprisingly, intestinal GLUT2 deletion leads to a strong loss in enteroendocrine L cell density, with no impact on GLP-1 plasma levels. This study highlights critical roles for GLUT2 in sugar absorption and enteroendocrine cell function management. The use of specific GLUT2 inhibitors could be considered to limit body weight gain and metabolic disorders induced by sugar rich diets.
95

Deciphering the Mechanism of G9a Spreading Genome-wide

Yevstafiev, Dmytro January 2015 (has links)
The cell differentiation process is associated with activation and repression of different genes, whereby the formation of heterochromatin is mediated by spreading of repressor proteins along large chromatin domains. Some of these proteins are methyltransferases, including GLP and G9a that are implicated in the addition of mono- and dimethyl groups to lysine 9 at Histone 3. Despite extensive research the exact mechanism of binding and spreading of G9a and GLP is unclear. To better understand the molecular mechanisms through which G9a and GLP bind to chromatin we tested the in vivo binding of a mutant G9a that is unable to bind to H3K9me2 histone marks via its Ankyrin domain. Murine erythroleukemia (MEL) cell line with expression of mutant G9a was generated using recombinant DNA technologies; G9a binding targets genome-wide were detected by the analysis of ChIP-sequencing data. We validated ChIP-sequencing data providing a reliable tool to visualize G9a targets in MEL cells. We also found that G9a Ankyrin mutant bound to all tested regions suggesting that the Ankyrin domain is not the only factor that contributes to the binding of G9a on chromatin in vivo.
96

Servicio de Abastecimiento de GLP de la empresa MIGAS LIMA SA

Bustamante Palomino, Liz Evelyn, Delgado Herrera, Rosa Guadalupe, Estupiñan Peralta, Sandra Sofia 12 July 2020 (has links)
La empresa comercializadora de servicios MIGAS LIMA S.A emprende en la atención del mercado de abastecimiento de GLP a granel para abastecimiento y venta a empresas en los distritos de Lince, San Isidro, Miraflores y Barranco. Actualmente, desea aprovechar las favorables condiciones que genera la alta demanda de GLP para desarrollar una nueva línea de servicio digital que permita estar más involucrados como proveedor y cliente. Esta empresa, en etapa de creación, ha encontrado la necesidad de abastecimiento de un mercado que no es 100% atendido por la poca oferta que existe en la venta y reparto de gas a granel, ya que en la región Lima solo cuentan con 3 grandes proveedores: PETROPERÚ (Villa el Salvador), REPSOL (Ventanilla), LLAMAGAS (Independencia). Por lo tanto, el objetivo de este trabajo de investigación es demostrar la viabilidad del proyecto de MIGAS LIMA S.A en la búsqueda de desarrollar un proceso de venta y abastecimiento sólido y constante para su cartera de clientes y potenciales compradores, creando eficiencia e innovación desde las actividades principales de su cadena de valor, sobre todo en el plan de acción de su cadena logística e innovando en el sistema de control de consumo del gas y formas de facturación a través de un aplicativo que manejara de manera remota estas actividades en interacción con el cliente. / The service company MIGAS LIMA S.A undertakes to service the bulk LPG supply market for supply and sale to companies in the districts of Lince, San Isidro, Miraflores and Barranco. Currently, it wants to take advantage of the favorable conditions generated by the high demand for LPG to develop a new digital service line that allows it to become more involved as a supplier and customer. This company, in the creation stage, has found the need to supply a market that is not 100% served by the low supply that exists in the sale and distribution of bulk gas, since in the Lima region they only have 3 large suppliers: PETROPERÚ (Villa el Salvador), REPSOL (Ventanilla), LLAMAGAS (Independencia). Therefore, the objective of this research work is to demonstrate the viability of the MIGAS LIMA SA project in the search to develop a solid and constant sales and supply process for its portfolio of clients and potential buyers, creating efficiency and innovation from the main activities of its value chain, especially in the action plan of its logistics chain and innovating in the gas consumption control system and billing methods through an application that remotely manages these activities in interaction with the client. / Trabajo de investigación
97

Maltooligosaccharide Chemosensation By Intestinal Enteroendocrine L-Cells Regulates the Endogenous Release of Gut Hormones and Contributes to Weight Management In Vivo

Marwa Mohamed Mohamed El Hindawy (5929655) 14 January 2021 (has links)
<p>As obesity has become one of the most prevalent metabolic diseases, and diabetes mellitus has become the seventh leading causes of death in the United States, alternative food/nutrition-based approaches to tackle obesity that are both efficacious and cost effective are in high demand. Since starch and its derived products are the principal dietary supply of glucose, strategies of using slowly digestible starch to achieve moderated glycemic response and prolonged glucose delivery, as well as to locationally digest starch into the ileum, have shown successful results such as moderation of insulinemia and reducing food intake in obese animals. An important regulator of appetite suppression is the neuroendocrine system of the gut-brain axis. Glucagon-like peptide-1 (GLP-1), oxyntomodulin (OXM), and peptide YY (PYY) are the main anorexigenic peptide products of the intestinal enterendocrine L-cells that regulate postprandial insulin levels as well as satiety signals. The stimulation of the enteroendocrine L-cells throughout the gastrointestinal tract through glucose, fatty acids and proteins has been extensively studied and confirmed. However, the stimulatory effect of complex dietary carbohydrates on L-cells is not described. In this dissertation, we investigated the <i>in vitro</i> intestinal cell chemosensation of L-cells to α-amylase starch digestion products, named maltooligosaccharides (MOS), and in the possible application of using slowly digestible starch delivery of MOS <i>in vivo</i>.</p> <p>In Chapter II of this dissertation, we reported a significantly higher stimulatory effect of MOS on GLP-1 and OXM secretion compared to glucose in mouse and human L-cells, respectively. Additionally, maltotriose enhanced the relative expression of the gastrointestinal peptide, cholecystokinin. Moreover, MOS exhibited protective effects on barrier function and monolayer integrity of intestinal epithelial cells. </p> <p>In Chapters III and IV, we performed a multiomics approach where transcriptomic analysis and global protein profiling of mouse L-cells treated with different types of MOS showed that the carbohydrates exhibit their effects through the induction of exocytosis of GLP-1- or OXM-containing vesicles and not through a positive regulation of the proglucagon gene expression. It is suggested that MOS induce higher secretion, but not higher synthesis, of the proglucagon gene products. In addition, maltotriose treatment downregulated the relative expression of the glucotoxicity marker, thioredoxin-interacting protein, and upregulated the relative expression of tight junction proteins supporting a role of MOS in barrier function integrity.</p> <p>Translating the <i>in vitro</i> findings into an <i>in vivo</i> application that is beneficial for human health required the use of controllable tool for the delivery of MOS throughout the small intestine for sensing by a higher number of L-cells. Slowly digestible starch (SDS), compared to rapidly digestible starch, provided such a tool. For this purpose, we used alginate-entrapped SDS microspheres that digest distally into the ileum to examine the role of SDS in the intervention and prevention of obesity in C57BL/6J diet-induced obese (DIO) and lean mice models.</p> <p>Results showed that 20% SDS in low-fat diets significantly improved weight loss and food intake reduction in DIO mice converted to low-fat diet for 12 weeks. Similarly, 15% SDS in high-fat diets showed significant reduction in body fat percent and significant increase in lean body mass as well as considerable reduction in weight gain rate and food intake in lean mice fed on 45% of calories high-fat diet. Immunohistochemistry of small intestine of mice in both the intervention and prevention studies revealed an even and thorough distribution of GLP-1 positive L-cells.</p> <p>Overall, this dissertation proposes several insights into L-cell sensation of dietary starch-degraded MOS delivered by the consumption of slowly digestible starch. MOS exhibit unique influences on L-cell sensitivity and gut hormone productivity. Future research investigating the mechanisms of intestinal sensing of MOS, as well as the development of bioactive carbohydrate structures that could preserve body weight and modulate glucose tolerance <i>in vivo</i> is needed to translate these findings into nutritional recommendations and food products beneficial for human health. The intricate role of dietary carbohydrates on gut physiological response, related to satiety and food intake could be a new approach for design of foods for health applications.</p>
98

Non-invasive evaluation of GPR119 agonist effects on β-cell mass in diabetic male mice using ¹¹¹In-exendin-4 SPECT/CT / ¹¹¹インジウム標識exendin-4 SPECT/CTを用いた、糖尿病モデル雄マウスでのGPR119アゴニストによる膵β細胞保護効果の非侵襲的評価

Murakami, Takaaki 23 March 2020 (has links)
京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22358号 / 医博第4599号 / 新制||医||1042(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 長船 健二, 教授 岩田 想, 教授 富樫 かおり / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM
99

Liraglutids viktminskningseffekt

Hazime, Zahraa January 2020 (has links)
Bakgrund: Fetma klassificeras som en sjukdom, medan övervikt klassificeras som en riskfaktor för andra sjukdomar såsom typ 2-diabetes (T2D). Genom att beräkna ”body mass index” (BMI) kan vikten klassificieras. Ett BMI &gt;25 kg/m2 klassificieras som övervikt medan BMI &gt;30 kg/m2 klassificieras som fetma. Övervikt hos asiater klassificieras vid BMI &gt;24 kg/m2 och fetma vid BMI &gt; 28 kg/m2 . Orsaken bakom övervikt och fetma kan vara negativa levnadsvanor, ärftlighet och läkemedelsbehandlingar. Fetma är förknippad med flera komplikationer som bland annat metabola syndromet, typ 2-diabetes (T2D) och hjärtkärlsjukdomar. Fetma kan behandlas genom kostintervention och ökad fysisk aktivitet men även genom läkemedel. Orlistat, liraglutid och bupropion i kombination med naltrexon är registrerade i Sverige för behandling av övervikt och fetma. Liraglutid är en GLP-1-analog som används vid behandling av T2D och där viktminskning upptäckts som en biverkan. Syfte: Syftet med detta examensarbete var att genom litteraturstudier undersöka ifall liraglutid har en viktminskningseffekt hos patienter med eller utan T2D. Metod: Detta examensarbete är en undersökning baserad på litteraturstudier. Genom att använda sökorden ”Liraglutide, weight loss, diabetes, BMI” samt ”Efficacy of liraglutide weight loss with type 2 diabetes SCALE” inkluderades 5 kliniska studier som analyserades. Resultat: Den största viktminskningen sågs hos patienter som behandlades med liraglutid 3,0 mg. Patienterna utan T2D som behandlades med 3,0 mg fick en viktminskning på 8,4±7,3 kg standardavviklese (SD) efter 56 veckors behandling. Patienter utan T2D som behandlades med lliraglutid 3,0 mg fick en viktminskning på 9,2 kg i samband med GI biverkningar och de som inte upplevde GI biverkningar fick en viktminskning på 6,3 kg. Patienter med T2D som behandlades med liraglutid 3,0 mg fick en genomsnittlig viktminskning på 6,4 kg efter 56 veckors behandling. Liraglutid 1,8 mg gav en genomsnittlig viktminskning på 6,0 kg och liraglutid 1,2 mg gav en genomsnittlig viktminskning på 5,1 kg. Slutsats: Liraglutids viktminskningseffekt var dosberoende hos patienter med övervikt eller fetma. Viktminskningseffekten påverkades av både BMI och GI biverkningar. Ju högre BMI patienten hade desto större viktminskning fick patienterna. Även ju längre tid som GI biverkningar såsom illamående, kräkningar och diarré varade desto mer gick patienterna ner i vikt. Viktminskningen redovisades i både procent och kilogram beroende på studierna.
100

Farmakologisk behandling vid fetma : Semaglutid versus liraglutid

Nilsson, Natalié January 2021 (has links)
Obesity is a health problem that is increasing worldwide and has high socioeconomic impact. In Sweden, obesity costs the society 70 billion SEK every year. For the year 2030, the Institute for Health and Medical Care Economics predicts that obesity can cost the society up to 17 billion SEK more than in 2018. In Sweden, 52% of the citizens 16-84 years of age are either overweight or obese.  The main factor behind obesity is still unidentified. What is known, and almost self-evident, is that weight gain occurs when energy consumption is lower than energy intake. The calorie intake during a day should be 1600-3000 calories and physical activity is important. For weight loss, the focus is mostly on calorie intake, but it is also important to consider the metabolic homeostasis which is regulated by hormones. Obesity can occur when there is a disturbance in the homeostatic mechanisms. One of the most important regulatory hormones is glucagon-like-peptide-1 (GLP-1) which stimulates satiety. Liraglutide and semaglutide are both GLP-1-analogues and are used in the treatment of type 2 diabetes. Liraglutide is also indicated in obesity and semaglutide as an anti-obesity drug has just undergone a phase 3 study. The mechanism of action of GLP-1-analogues in obesity is to stimulate a feeling of satiety, which leads to a lower energy intake and thus weight loss.  The aim of this thesis was to evaluate whether semaglutide can be used as an anti-obesity drug and the effect and safety of the substance compared with the already approved drug liraglutide.  The thesis is a literature study that uses five randomized clinical trials from the database PubMed. Of the six scientific articles, two examine liraglutide for 56 weeks, two semaglutide for 68 weeks and one both drugs for 52 weeks.  All studies demonstrate that semaglutide has a better effect on reducing body weight and waist measurement than liraglutide. In study 5, semaglutide above 1,4 mg per week is shown to have a statistically significantly better weight loss effect compared to liraglutide. Gastrointestinal side effects were the most common side effects in all included studies. The majority of these were of mild or moderate intensity. Of the gastrointestinal side effects, nausea was most common. In the semaglutide groups, the total side effects were slightly more frequent than in the liraglutide groups, which is mainly shown in study 5. Possible factors affecting the results is whether the participants receive IBT or lifestyle advice in combination with the treatment.  Conclusions that can be drawn from the studies is that semaglutide is more effective in terms of weight loss and reduction of waist measurements compared to liraglutide. The adverse reactions were generally similar between semaglutide and liraglutide. Semaglutide should currently be administered with caution and under supervision. More studies need to be conducted to control the dosage and safety.

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