Metformina: más allá del control glucémico

Abstract

RESUMENIntroducción: la metformina es una biguanida que disminuye gluconeogénesis e incrementa la recaptación de glucosa en los músculos, sin embargo, más allá del glucémico se han documentado beneficios adicionales como la disminución de complicaciones crónicas derivadas de la hiperglucemia, entre ellas las cardiovasculares y del síndrome metabólico per se. Objetivo: identificar los efectos de la metformina diferentes al control control glucémico en población con diabetes mellitus, con el fin de contribuir a difundir el conocimiento. Materiales y método: tres revisores independientes realizaron la búsqueda en distintas bases de datos entre ellas Pubmed y ScienceDirect, utilizando los términos Metfomin AND Cardiovascular disease AND inflamatory response AND Hyperlipidemia, Biguanides, Diabetes Mellitus, Diabetes complications, Obesity, Vascular diseases AND Cancer; y Metfomina y enfermedad cardiovascular, metformina y cáncer se seleccionaron los artículos desde el año 2010, encontrando 13 828 artículos, de los cuales se incluyeron 144. Conclusión: más allá del control glucémico, la metformina, modifica la "memoria metabólica", reduce mediadores inflamatorios y el grosor de pared arterial, disminuye factores trombóticos y reduce la prevalencia de falla cardiaca logrando impactar la morbimortalidad y mediante cambios moleculares o genéticos, tiene potencial uso como anticancerígeno. El clínico debe conocer estos efectos para favorecer su pronto inicio en los casos indicados. Metformin: beyond the glycemic targetABSTRACT Introduction: the metformin is a biguanide which main action is to decrease hepatic glucose output, primarily by decreasing gluconeogenesis, and increase glucose uptake by muscles. However, beyond the glycemic target, additional benefits have been documented like a decrease in chronic complications to hyperglycemia, including cardiovascular comorbility and metabolic syndrome. Objetive: to identify effects of metformin other than glycemic control in patients with diabetes mellitus in order to help disseminate knowledge. Materials and methods: three independent reviewers searched in different databases of PubMed and ScienceDirect using the DeCS and MeSH terms: Metfomin AND Cardiovascular disease AND inflamatory response AND Hyperlipidemia, Biguanides, Diabetes Mellitus, Diabetes complications,Obesity, Vascular diseases AND Cancer, selecting the items since 2010 year and prior to warrant mention. Search based publications that were considered most relevant and, additionally, a manual search of the referenced articles in publications retrieved in the initial search was conducted, 13 828 articles were found but 144 were included finally. Conclusion: beyond glycemic control, Metformin, modifies the "metabolic memory", reduces inflammatory mediators and thickness of arterial wall, decreases thrombotic factors and reduces the prevalence of heart failure making an impact morbidity and mortality and because of molecular or genetic changes, it has potential use as anticarcinogenic. The physicians should know...

Effects of the combination of Cnidoscolus aconitifolius and Metformin on the glycemia in streptozotocin-induced diabetes rats

“…On the other hand, Caballero et al (2017) has explained that oxidative stress and glycosylation of mitochondrial proteins involve the transcriptional factor NF-kB, NADPHoxidase and the pro-apoptotic gene BAX. He explained that the NADPH generated from the metabolism of glucose plays an important role in oxidative stress through the reduction of hydrogen peroxide whose enzymatic mechanisms are associated with NF-kB, and whose expression increases in hyperglycemia.…”

Diabetes, Allopathic and Alternative Methods (Kombucha) for Its Treatment

“…In the liver, cation receptors called OCT-1 are located, which allow the entry of metformin into the hepatocyte, causing an inhibition in the respiratory chain of the mitochondria and increasing its concentration in the cytoplasm, this has as a consequence an increase in ATP energy; ADP and AMP, which leads to a decrease in glucose production and at the same time an AMPK protein stimulates insulin action [44]. It is administered orally, its absorption occurs in the small intestine, its half-life is from 1.30 to 5 hours, it is not metabolized and its elimination is renal.…”

Effect of Kombucha and Its Non-Polar Components on Morphological Aspects of the Pancreas of Diabetic Rats with Streptozotocin

“…The main allopathic drugs are from four groups: sulfonylureas (glibenclamide, gliclazide, glimepiride, and glipizide [23] [24], are administered orally, are metabolized in liver, with inactive metabolite products that are eliminated in the urine or through the bile [25]. The biguanides (metformin, phenformin and buformin), originate from the gaudiniana, an active ingredient that is obtained from the Galega officinalis [26] [27]. The thiazolidinediones or glitazones: troglitazone, rosiglitazone, glitazone and pioglitazone [28] [29]), of which only the last two are still used as safe hypoglycemic agents [24].…”