Repensando o tratamento do Diabetes Parte I: Glibenclamida. Usar ou não?

  3 artigos para direcionar a discussão

 1-  “Impact of Type of Preadmission Sulfonylureas on  Mortality and Cardiovascular Outcomes in Diabetic Patients with Acute Myocardial Infarction”  J. Clin. Endocrinol. Metab; , doi: 10.1210/jc.2010-0449 

O estudo apresentado, foi realizado em centros de terapia intensiva que recebiam pacientes com IAM e diabeticos na França. O objetivo foi comparar o desfecho entre os pacientes de acordo com a terapia realizada pelos mesmos em domicílio antes do IAM. 

 2 – “Comparison of two sulfonylureas with high and low myocardial KATP  channel affinity on myocardial infarct size and metabolism in a rat model of type 2 diabetes Diabetologia (2011) 54:451–458 DOI 10.1007/s00125-010-1970-y

Estudo avalia modelos ex vivos de camungos com e sem DM2 comparando grupos  sem tratamento e com tratamento com glibenclamida e gliclazida.

3- “Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction”: a nationwide study European Heart Journal doi:10.1093/eurheartj/ehr077

Estudo avalia  grupo da população dinamarquersa diabetica  visando avaliar causas de mortalidade e risco cardiovascular.  Com ou sem IAM prévio e uso de metformina e  ou sulfonilureias.

 

Esta entrada foi publicada em Diabetes Tipo 2, Sem categoria. Adicione o link permanenteaos seus favoritos.

11.289 respostas a Repensando o tratamento do Diabetes Parte I: Glibenclamida. Usar ou não?

  1. CODDHI 2011 disse:

    Em relação ao estudo 1 algumas críticas devem ser feitas . As tabelas de um estudo devem ser auto -explicativas, porém as do estudo acima são muito confusas, não conseguindo elucidar o resultado do mesmo.

    Aparentementemente não houve uma relação entre o risco cardiovascular e o uso das sulfoniluréias (independente de ser glibenclamida ou sulfonilureias mais novas) . Houve um risco aumentado nos pacientes sem tratamento.

    Temos que refletir e devem ser feitos mais estudos antes de condenar as sulfonilkureias.

  2. Guilherme disse:

    O Artigo 2 avalia camundongos ex vivo. As conclusoes nem sempre se confirmam em camundongos in vivo. Importante lembrar que o uso de glibenclamida e gliclazida foi feito de forma aguda, nos dois grupos do estudo, durante e apos a isquemia miocardica. Fato que nao ocorre no tratamento de IAM em humanos. O estudo argumenta que ratos diabeticos possuem maior glicogenio miocardico que os não diabeticos, o que diminuiria a extensão do infarto. Estudos em humanos precisam ser feitos para se comprovar tal teoria.

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  3. Luiz Carlos disse:

    Reafirmo as opiniões de meus colegas e chega a conclusão que as Sulfoniluréias ainda tem um papel fundamental no tratamento do Diabetes tipo 2, especialmente em países em desenvolvimento como o Brasil. O primeiro estudo (francês) tem erros metodológicos, como a dificuldade de entender a tabela 1 já que a soma dos casos não é compatível com a porcentagem apresentada. Os demais estudos são experimentais e não tem evidência suficiente para crucificar a Glibenclamida, uma Sulfa não seletiva frenta a Gliclazida (seletiva). Acredito que a Glibenclamida ainda é uma importante droga e tem o seu lugar quando utilizada com parcimônia. Não vamos crucificar as sulfas pois o UKPDS já mostrou que elas são capazes de reduzir eventos micro e macrovasculares e tem mais poder em reduzir a HbA1c frente a drogas modernas como as Gliptinas.

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