{"id":5285,"date":"2023-11-26T13:31:50","date_gmt":"2023-11-26T13:31:50","guid":{"rendered":"https:\/\/dfpharmaco.com\/diyabetin-yeni-ilac-tedavisine-genel-bakis\/"},"modified":"2023-11-26T13:31:50","modified_gmt":"2023-11-26T13:31:50","slug":"diyabetin-yeni-ilac-tedavisine-genel-bakis","status":"publish","type":"post","link":"https:\/\/dfpharmaco.com\/en\/diyabetin-yeni-ilac-tedavisine-genel-bakis\/","title":{"rendered":"Diyabetin yeni ila\u00e7 tedavisine genel bak\u0131\u015f"},"content":{"rendered":"

1. Giri\u015f<\/strong><\/p>\n

Diyabette t\u0131bbi bak\u0131m standartlar\u0131, Amerikan Diyabet Derne\u011fi (ADA) taraf\u0131ndan sa\u011flanan klinik uygulama \u00f6nerilerini i\u00e7erir ve diyabet bak\u0131m\u0131n\u0131n ayr\u0131nt\u0131lar\u0131n\u0131, genel tedavi hedeflerini ve k\u0131lavuzlar\u0131n\u0131 ve bak\u0131m\u0131n kalitesini de\u011ferlendirmeye y\u00f6nelik ara\u00e7lar\u0131 sa\u011flamay\u0131 ama\u00e7lar. Bu yaz\u0131da diyabetin ila\u00e7 tedavisi ele al\u0131nacakt\u0131r.<\/p>\n

2- \u0130la\u00e7 tedavisi<\/strong><\/p>\n

2-1- Tip 1 diyabet<\/strong><\/p>\n

2-1-1-ins\u00fclin<\/strong><\/p>\n

Tip 1 diyabet, pankreatik beta h\u00fccrelerinin hareketsizli\u011fi ile karakterize edilir, bu nedenle tip 1 diyabetli t\u00fcm insanlar i\u00e7in ins\u00fclin tedavisi gereklidir. Son otuz y\u0131lda biriken kan\u0131tlara g\u00f6re, g\u00fcn boyunca \u00e7oklu ins\u00fclin enjeksiyonlar\u0131 (bazal ve prandiyal) yoluyla ins\u00fclin replasman\u0131 veya bir ins\u00fclin pompas\u0131yla s\u00fcrekli subkutan enjeksiyon (CSII), tip 2 diyabetli ki\u015filerde en iyi etkinlik ve g\u00fcvenlik kombinasyonuna sahiptir. ilk kez vard\u0131 DCCT \u00e7al\u0131\u015fmas\u0131, bu ins\u00fclin replasman y\u00f6nteminin mikrovask\u00fcler ve makrovask\u00fcler komplikasyonlarda %50’lik bir azalma ile ili\u015fkili oldu\u011funu g\u00f6stermi\u015ftir. Ancak bu y\u00f6ntemlerde hipoglisemi riski daha y\u00fcksektir. Yatak ba\u015f\u0131nda s\u00fcrekli glikoz monit\u00f6rlerinin kullan\u0131lmaya ba\u015flanmas\u0131yla bu risk azald\u0131. \u00d6rne\u011fin, tip 1 diyabetli ki\u015filerde gece hipoglisemisinin, \u00f6nceden belirlenmi\u015f bir glikoz seviyesinde ins\u00fclin da\u011f\u0131t\u0131m\u0131n\u0131 otomatik olarak ask\u0131ya alan glikoz sens\u00f6rl\u00fc ins\u00fclin pompalar\u0131 kullan\u0131larak g\u00f6zlemlendi\u011fi g\u00f6zlemlenmi\u015ftir.<\/p>\n

Son zamanlarda daha h\u0131zl\u0131 etki profiline sahip iki yeni ins\u00fclin t\u00fcr\u00fc form\u00fcle edilmi\u015ftir:<\/strong><\/p>\n

A) H\u0131zl\u0131 etkili ins\u00fclinler veya RAA ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda en y\u00fcksek etkiye daha h\u0131zl\u0131 ula\u015fan ve etki s\u00fcresi daha k\u0131sa olan inhale insan ins\u00fclini, daha d\u00fc\u015f\u00fck hipoglisemi ve kilo alma riskiyle ili\u015fkilendirilebilir.<\/p>\n

b) Daha h\u0131zl\u0131 etkili ins\u00fclin aspart[5] ve ins\u00fclin lispro-aabc[6] muhtemelen prendiyal kan \u015fekerini RAA’dan daha iyi d\u00fc\u015f\u00fcr\u00fcr. Diyabet y\u00f6netiminde bu fakt\u00f6rlerin net bir yerini belirlemek i\u00e7in daha fazla ara\u015ft\u0131rmaya ihtiya\u00e7 vard\u0131r.<\/p>\n

Ek olarak, daha yeni, daha uzun etkili bazal ins\u00fclin analoglar\u0131 (glarjin U-300 (Togeo gibi) veya degludec[7]), tip 1 diyabetli hastalarda glarjin U-100 ile kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda daha d\u00fc\u015f\u00fck hipoglisemi riskine sahip olabilir.<\/p>\n

Genel olarak tip 1 diyabetli hastalar g\u00fcnl\u00fck ins\u00fclinlerinin %50’sini bazal, %50’sini ise ins\u00fclin olarak al\u0131rlar. Toplam g\u00fcnl\u00fck ins\u00fclin ihtiyac\u0131 a\u011f\u0131rl\u0131\u011fa g\u00f6re tahmin edilebilir; Bu \u015fekilde hastan\u0131n a\u011f\u0131rl\u0131\u011f\u0131n\u0131n g\u00fcnl\u00fck kilogram\u0131 ba\u015f\u0131na 0,4-1 \u00fcnite dikkate al\u0131n\u0131r, bu da ergenlik, hamilelik veya baz\u0131 hastal\u0131k durumlar\u0131nda ins\u00fclin dozunun \u00fcst s\u0131n\u0131r\u0131n\u0131 gerektirebilir. Ancak genellikle metabolik durumu stabil olan ki\u015filerde g\u00fcnde 0,5 \u00fcnite\/kg ins\u00fclin dozuna (dozun yar\u0131s\u0131 temel kan \u015fekerini kontrol etmek i\u00e7in, di\u011fer yar\u0131s\u0131 da yemekten sonra kan \u015fekerini kontrol etmek i\u00e7in) ba\u015flan\u0131r.<\/p>\n

G\u00fcnde birka\u00e7 kez yap\u0131lan enjeksiyon \u015feklindeki ins\u00fclin rejimi, gece ve oru\u00e7ta kan \u015fekerini kontrol etmek i\u00e7in gece uzun etkili ins\u00fclin enjeksiyonlar\u0131n\u0131 ve yemeklerden sonra kan \u015fekerini kontrol etmek i\u00e7in k\u0131sa etkili ins\u00fclinleri i\u00e7erir.<\/p>\n

Prandiyal ins\u00fclin enjeksiyonunun uygun zamanlamas\u0131 ins\u00fclinin farmakokineti\u011fine (d\u00fczenli, h\u0131zl\u0131 etkili (RAA), inhale), yemek \u00f6ncesi kan \u015fekeri d\u00fczeylerine ve karbonhidrat al\u0131m\u0131na ba\u011fl\u0131d\u0131r. Fizyolojik ins\u00fclin sekresyonu kan \u015fekerine, \u00f6\u011f\u00fcn b\u00fcy\u00fckl\u00fc\u011f\u00fcne ve dokular\u0131n glukoz gereksinimlerine g\u00f6re de\u011fi\u015fir.Bu nedenle, hastalar\u0131n t\u00fcketilen karbonhidrat miktar\u0131, yemek \u00f6ncesi glukoz d\u00fczeyleri ve beklenen aktivite dikkate al\u0131narak prandiyal ins\u00fclinin nas\u0131l ayarlanaca\u011f\u0131 konusunda e\u011fitilmesi yard\u0131mc\u0131 olabilir. etkili olmak.<\/p>\n

2-1-2-ins\u00fclin d\u0131\u015f\u0131 tedaviler<\/strong><\/p>\n

Pramelinitid[8]
\nPramlintid, beta h\u00fccrelerinden do\u011fal olarak salg\u0131lanan ve tip 1 diyabetli yeti\u015fkinlerde kullan\u0131m\u0131 onaylanm\u0131\u015f amilin peptidine dayanmaktad\u0131r. Klinik \u00e7al\u0131\u015fmalardan elde edilen sonu\u00e7lar, A1C (%0-0,3) ve v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131nda (1-2 kg) de\u011fi\u015fken azalmalar g\u00f6stermi\u015ftir. ) ins\u00fcline pramelinitidin eklenmesiyle g\u00f6sterilmi\u015ftir.<\/p>\n

metformin<\/strong>
\nTip 1 diyabetli eri\u015fkinlerde metforminin eklenmesi v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131nda ve lipit d\u00fczeylerinde k\u00fc\u00e7\u00fck bir azalmaya neden olur, ancak A1C’yi iyile\u015ftirmez.<\/p>\n

GLP-1 resept\u00f6r agonistleri[9]<\/strong>
\nTip 1 diyabet hastalar\u0131nda ins\u00fcline GLP-1 resept\u00f6r agonistlerinin (liraglutid[10] veya exentid[11]) eklenmesi A1C’de tek ba\u015f\u0131na ins\u00fcline g\u00f6re hafif bir d\u00fc\u015f\u00fc\u015fe (%0,2) neden oldu ve ortalama a\u011f\u0131rl\u0131k 3 kg azald\u0131.<\/p>\n

SGLT2 inhibit\u00f6rleri[12]<\/strong>
\n\u0130ns\u00fclin tedavisine bir SGLT2 inhibit\u00f6r\u00fcn\u00fcn eklenmesi, tek ba\u015f\u0131na ins\u00fcline k\u0131yasla A1C ve v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131ndaki iyile\u015fmelerle ili\u015fkilidir. Ancak tip 1 diyabette SGLT2 inhibit\u00f6rlerinin kullan\u0131m\u0131 ketoasidozda iki ila d\u00f6rt kat art\u0131\u015fla ili\u015fkilidir.<\/p>\n

Bahsedilenlere g\u00f6re \u015fu ana kadar tip 1 diyabet tedavisinde yaln\u0131zca pramelinitid onaylanm\u0131\u015ft\u0131r, di\u011fer yard\u0131mc\u0131 ajanlar i\u00e7in ise daha ileri \u00e7al\u0131\u015fmalara ihtiya\u00e7 vard\u0131r.<\/p>\n

2-1-3-Cerrahi<\/strong><\/p>\n

Pankreas ve Langerhans adac\u0131k h\u00fccrelerinin nakli [13] kan \u015fekeri seviyesini normalle\u015ftirebilir ve tip 1 diyabetin mikrovask\u00fcler komplikasyonlar\u0131n\u0131 azaltabilir. Ancak bu t\u00fcr hastalar\u0131n \u00f6m\u00fcr boyu organ nakli reddini \u00f6nlemek i\u00e7in ba\u011f\u0131\u015f\u0131kl\u0131k sistemini bask\u0131lay\u0131c\u0131 ila\u00e7lar almas\u0131 gerekiyor. Bu nedenle, imm\u00fcn bask\u0131lay\u0131c\u0131larla tedavinin olas\u0131 yan etkileri g\u00f6z \u00f6n\u00fcne al\u0131nd\u0131\u011f\u0131nda, ayn\u0131 anda b\u00f6brek nakli yap\u0131lan hastalarda veya kan \u015fekerinin yo\u011fun ve konsantre tedavisine ra\u011fmen s\u0131k s\u0131k ketoasidoz veya ciddi hipoglisemi ataklar\u0131 ge\u00e7iren ki\u015filerde pankreas nakli d\u00fc\u015f\u00fcn\u00fclmelidir.<\/p>\n

 <\/p>\n

\u015eekil 1 tip 1 diyabetin tedavisini \u00f6zetlemektedir.<\/p>\n","protected":false},"excerpt":{"rendered":"

1. Giri\u015f Diyabette t\u0131bbi bak\u0131m standartlar\u0131, Amerikan Diyabet Derne\u011fi (ADA) taraf\u0131ndan sa\u011flanan klinik uygulama \u00f6nerilerini i\u00e7erir ve diyabet bak\u0131m\u0131n\u0131n ayr\u0131nt\u0131lar\u0131n\u0131, genel tedavi hedeflerini ve k\u0131lavuzlar\u0131n\u0131 ve bak\u0131m\u0131n kalitesini de\u011ferlendirmeye y\u00f6nelik ara\u00e7lar\u0131 sa\u011flamay\u0131 ama\u00e7lar. Bu yaz\u0131da diyabetin ila\u00e7 tedavisi ele al\u0131nacakt\u0131r. 2- \u0130la\u00e7 tedavisi 2-1- Tip 1 diyabet 2-1-1-ins\u00fclin Tip 1 diyabet, pankreatik beta h\u00fccrelerinin hareketsizli\u011fi […]<\/p>\n","protected":false},"author":1,"featured_media":5119,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,54],"tags":[],"class_list":["post-5285","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-blog","category-blog-en"],"acf":[],"featured_image_src":{"landsacpe":["https:\/\/dfpharmaco.com\/wp-content\/uploads\/2023\/11\/diabetes-min-1.png",400,400,false],"list":["https:\/\/dfpharmaco.com\/wp-content\/uploads\/2023\/11\/diabetes-min-1-400x348.png",400,348,true],"medium":["https:\/\/dfpharmaco.com\/wp-content\/uploads\/2023\/11\/diabetes-min-1-300x300.png",300,300,true],"full":["https:\/\/dfpharmaco.com\/wp-content\/uploads\/2023\/11\/diabetes-min-1.png",400,400,false]},"_links":{"self":[{"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/posts\/5285","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/comments?post=5285"}],"version-history":[{"count":0,"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/posts\/5285\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/media\/5119"}],"wp:attachment":[{"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/media?parent=5285"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/categories?post=5285"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/dfpharmaco.com\/en\/wp-json\/wp\/v2\/tags?post=5285"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}