nÃo hà / Diabetes mellitus (DM) à uma sÃndrome associada a secreÃÃo de insulina deficiente, resistÃncia à aÃÃo da insulina ou uma associaÃÃo de ambas. Caracteriza-se por hiperglicemia crÃnica que a longo prazo poderà causar retinopatia, nefropatia, neuropatia perifÃrica e autonÃmica. Este estudo do tipo intervencionista, prospectivo e aberto teve como objetivo avaliar a eficÃcia terapÃutica da sitagliptina no controle metabÃlico do diabetes mellitus do tipo 2 recentemente diagnosticado (menos de seis meses) e nas vias de conduÃÃo nervosa somato-sensitiva e visual. Antes de iniciar o tratamento, foram avaliados os Ãndices antropomÃtricos e a pressÃo arterial. TambÃm foram realizadas as dosagens em jejum de triglicerÃdeos, colesterol total, colesterol de alta densidade (HDL), gama glutamil transferase, aspartato amino transferase, alanina amino transferase, proteÃna C reativa, microalbuminÃria, Ãxido nÃtrico, glicose, hemoglobina glicada (A1C), peptÃdeo C, insulina e glucagon. ApÃs um estÃmulo alimentar de 566 Kcal foram feitas coletas de sangue seriadas durante 3 horas nos tempos de 5, 15, 30, 45, 60, 90, 120, 150 e 180 minutos para a dosagem de glicose, insulina e glucagon com a construÃÃo da Ãrea sob a curva (AUC) destes analitos. Um subgrupo de 20 pacientes realizou ainda, anÃlises seriadas das incretinas (GLP-1 ativo e GIP total) apÃs estÃmulo alimentar e, tambÃm, exames eletroneurofisiolÃgicos (potenciais evocados somato-sensitivos â PESS, e visuais - PEV). ApÃs estas avaliaÃÃes, os pacientes receberam sitagliptina 100 mg (1 comprimido/dia) por um perÃodo de 3 meses, apÃs o qual, eles retornaram para avaliaÃÃo clÃnica e para realizar todas as dosagens bioquÃmicas e os exames de PESS e PEV que haviam realizado no inÃcio do estudo. Dos 41 pacientes avaliados, 28 eram do sexo feminino e 13 do sexo masculino, idade mÃdia de 53,2  9,43 anos, em mÃdia obesos e 50% deles eram hipertensos. ApÃs o tratamento, observou-se a melhora dos Ãndices antropomÃtricos, de todos os parÃmetros laboratoriais com Ãnfase na glicose em jejum (prÃ: 174,43  67,18 e pÃs: 129,07  29,19 mg/dL), A1C (prÃ: 8,76  2,68 e pÃs: 6,64  1,11%) e Ãxido nÃtrico (prÃ: 85,21  44,02 e pÃs: 39,91  20,99 ÂM), todos com P<0,0001 e ainda, aumento da concentraÃÃo da AUC de GLP-1 ativo (P=0,003) e diminuiÃÃo da AUC de GIP total (P=0,001), bem como diminuiÃÃo das latÃncias N9D (P<0,0001), N13E (P=0,036), N20D (P=0,028) e dos tempos de conduÃÃo central N13-N9E (P=0,045), N20-N13D (P=0,044), alÃm de correlaÃÃes com significÃncia estatÃstica entre parÃmetros bioquÃmicos e eletroneurofisiolÃgicos. Este estudo concluiu que houve melhora clÃnica, metabÃlica e nas vias de conduÃÃo do impulso nervoso somato-sensitivo e visual dos pacientes tratados com sitagliptina. / Diabetes mellitus (DM) is a syndrome associated with deficient insulin secretion, resistance to insulin action or the combination of both. It is characterized by chronic hyperglycemia that in a long term can cause retinopathy, nephropathy, peripheral and autonomic neuropathy. The present interventional, prospective and open study was designed to evaluate therapeutic efficacy of sitagliptin in metabolic control of diabetes mellitus type 2 recently diagnosed (less than 6 months) and in pathways of visual and somatosensory nerve conduction. Blood pressure and anthropometric data were colected before treatment. Measures of fasting triglycerides, total cholesterol, high density lipoprotein cholesterol gamma glutamyl transpeptidase, alanine aminotransferase, aspartate aminotransferase, microalbumin, nitric oxide, glucose, glycated hemoglobin (A1C), C-peptide, insulin and glucagon were also collected. Also during the pre-study, after a feeding stimulus of 566 Kcal, biochemical evaluations were conducted of the metabolism in fasting and during 3 hours, in standard intervals of 5, 15, 30, 45, 60, 90, 120, 150 and 180 minutes for glucose, insulin and glucagon for design of the area under curve (AUC) of these analytes. In a subgroup of 20 patients were performed dosages in pre-fixed times of incretins (active Glucagon Like Peptide -1, GLP-1, and total Glucose-dependent Insulinotropic polypeptide, GIP) after feeding stimulus and electroneurophysiological tests (somatosensory evoked potentials - SEP, and visual - VEP). After these evaluations, the patients received sitagliptin 100 mg (1 tablet a day) for 3 months and then returned for clinical evaluation and to repeat all the biochemical dosages, SEP and VEP exams. From 41 patients evaluated, 28 were female and 13 male, the average age was 53.2  9.43 years, in average obese and 50% were hypertensive. After treatment, improvement was observed in all anthropometric and laboratory parameters, specially fasting glucose (pre: 174,43  67,18 mg/dL and post: 129,07  29,19 mg/dL), A1c (pre: 8,76  2,68 and post: 6,64  1,11%), and nitric oxide (pre: 85,21  44,02 and post: 39,91  20,99 ÂM), all with P<0.0001, and also increase in the concentration of the AUC of active GLP-1 (P=0.003), decrease of the AUC of total GIP (P=0.001), and decrease of the N9D (P<0.0001), N13E (P=0.036 ), N20D (P=0.028) latencies and of the central conduction time N13-N9E (P=0.045), N20-N13D (P=0.044). There were also statistically significant correlations between biochemical and electrophysiological parameters. This study concluded that there was clinical, metabolic and somatosensory and visual nerve impulse conduction pathways improvement in patients treated with sitagliptin.
| Identifer | oai:union.ndltd.org:IBICT/oai:www.teses.ufc.br:3671 |
| Date | 19 April 2010 |
| Creators | Joelma InesTagliapietra |
| Contributors | Maria Elisabete Amaral de Moraes, Renan MagalhÃes Montenegro JÃnior, Otoni Cardoso do Vale, Gilberto de Nucci, JanaÃna Serra Azul Monteiro Evangelista |
| Publisher | Universidade Federal do CearÃ, Programa de PÃs-GraduaÃÃo em Farmacologia, UFC, BR |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/doctoralThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFC, instname:Universidade Federal do Ceará, instacron:UFC |
| Rights | info:eu-repo/semantics/openAccess |
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