View in PDF Number of views: The international guidelines for the management of type 2 diabetes mellitus have seen many changes over the last decade.
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They have moved from a strict glycemic control in all peritoneal cancer trials 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.
The most preferred peritoneal cancer trials 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 peritoneal cancer trials in 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.
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 and 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 peritoneal cancer trials.
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Regarding the glucose control, in a meta-analysis, the HbA1c reduction at weeks was higher in studies that included peritoneal cancer trials patients, with a shorter peritoneal cancer trials 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.
Markman M: Intraperitoneal terapie în gestionarea peritoneale mezoteliom. Markman M: Intraperitoneal therapy in the management of peritoneal mesothelioma. Voi împarti acum fibros și membranele peritoneale Folosind o maniera circulara la nivelul colului. I will now divide the fibrous and peritoneal membranes using a circular manner at the neck. Produce spasme abdominale și simptome peritoneale.
There are ongoing studies with these antidiabetic agents expected to report their data in the near future.