This article addresses possible mechanisms for development of cardiovascular events (CVE) in type 2 diabetes mellitus (T2DM) patients treated with sulfonylurea derivatives (SU). Several problems are highlighted in this review, including molecular aspects of pancreatic and extrapancreatic action of these drugs, their comparative potential to induce hypoglycemic events (as predictors of acute CVE) and impairment of ischemic preconditioning, as well as antiarrhythmic activity of certain SU agents. Finally, efficacy and cardiovascular safety of glimepiride in T2DM patients is substantiated based on a survey of current literature.
Glibenclemide is the most effective drug among oral hypoglycemic ones. The efficacy of this drug is determined by its
With the growing prevalence of type 2 diabetes mellitus (T2DM) the possibility of treating it with available drugs is one of the main issues. Although glycemic control and reduction of micro- and macrovascular outcomes remain important aspects of treatment, the main limiting factors are the availability and cost of oral hypoglycemic agents. Although newer agents, such as sodium -glucose cotransporter 2 inhibitors, dipeptidyl peptidase-4 inhibitors and glucagon-like peptide 1 receptor agonists, potentially being valuable for patients with insulin resistance and cardiovascular complications, they are relatively expensive and have limited availability. Second-generation sulfonylureas effectively reduce glycated hemoglobin and contribute to the prevention of micro- and macrovascular complications of T2DM The review substantiates the role of Gliclazide MR as a more affordable drug for the treatment of T2DM, the safety of which has been confirmed by many studies; cardio-and nephroprotective effects are shown, as well as mechanisms for influencing в-cells of the pancreas and extrapancreatic effects through activation of phospholipase C and the G-protein-сoupled-receptors (GPCR) are analyzed. The latest data on the assessment of adverse events of Gliclazide MR are presented in comparison with both other sulfonylureas and glucose-lowering drugs of other classes.
We introduce the audience to the personal and professional life of M.I. Balabolkin ? a prominent Russian endocrinologist, scientist and a proliferous author. We highlight his contribution into the development of national endocrinology services, including the foundation of academic departments of endocrinology in 1977 (first in the nation) and in 1991 (in the Institute of Higher Professional Education, now part of the First Moscow Medical University). We also attempt to summarize professor Balabolkin?s educational and scientific heritage that encompasses studies on pathogenesis and clinical management of major endocrine disorders, as well as instruction of a multitude of successful clinicians and scientists.
Type 2 diabetes mellitus (DM2) is a chronic progressing disease associated with insulin resistance and impaired insulin secretion insufficient toovercome insulin resistance that deteriorates as a result of glucose toxicity and beta-cell apoptosis. Combination of metformin and sulfonylureas (SU) iscurrently regarded as an effective strategy of hypoglycemic therapy having effect not only on the main stages of pathogenesis but also on t dangerousrisk factors leading to adverse events (hypoglycemia, body weight increment, cardiovascular disorders). Amaryl, SU of the 3d generation, meets allcriteria of safety and efficacy for combined hypoglycemic therapy due to its high affinity to a specific subunit of SU receptors-1 on beta-cells coupled toshort-term stimulating action on insulin secretion. Moreover, it has a unique SU-unrelated extrapancreatic mechanism of action. The efficacy andsafety of Amaryl was confirmed in a number of clinical studies which gives reason to recommend it for inclusion in any modern hypoglycemic therapywith a minimal risk of hypoglycemia, lack of weight increment, positive effect on the cardiovascular system and progress of atherosclerosis
Aim. Determination of desialized apolipoprotein-B-100 (apoB-100) and lipoprotein-containing circulating immune complexes in patients with chronic kidney disease (CKD) in program hemodialysis with type 2 diabetes mellitus. Materials and methods. We examined 81 patients with CKD (50 men / 31 women) treated with program hemodialysis, of which 36 (17/19) with type 2 diabetes mellitus, 45 (33/12) non-diabetic patients. The levels of total cholesterol, triglycerides and desialylated apoB-100 in blood plasma and lipoprotein-containing circulating immune complexes. A color duplex scan of brachiocephalic arteries was used to assess the extent of development of atherosclerosis with the determination of the thickness of the intima-medial complex. Results and discussion. Patients with diabetes had high values of total cholesterol, triglycerides (p
Purpose Defining vascular calcification markers in patients on long-term hemodialysis (LTH) with type 2 diabetes mellitus (type 2 diabetes) and without type 2 diabetes. Materials and methods. The study was conducted in 82 patients with chronic kidney disease (CKD) (51 men, 31 women) on LTH, of which 25 patients (10 men, 15 women) had type 2 diabetes and 57 people (33 men, 24 women) had no diabetes. All patients underwent evaluation of calcium-phosphate metabolism, control of intact PTH (iPTH), inorganic phosphorus, and total calcium. All patients were tested for the level of fibroblast growth factor-23 (FGF-23) in blood serum using a multi-enzyme immunoassay kit, and the correlation between these parameters and the presence of vascular calcification was evaluated. Results. A correlation was found between the severity of vascular calcification and the calcium-phosphate metabolism. In the group with type 2 diabetes, there is a correlation between the level of FGF-23, iPTH, inorganic phosphorus and vascular calcification. There is also a correlation between the time on LTH and the increase in the level of FGF-23 in patients with type 2 diabetes. Conclusion. We obtained data that can indicate a more pronounced change in the vascular wall in patients with type 2 diabetes on LTH in comparison with patients without diabetes mellitus on LTH, which allows to associate high cardiovascular mortality in patients with type 2 diabetes on LTH with accelerated development of vascular calcification.
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