Yeka ukuthi loluhlobo lwamaMithi lungasiza kanjani ekulawuleni isifo sikashukela
Injectables engekho-insulin wuhlobo lwemithi ejojowe ngaphansi kokungena emathanjeni amafutha nge-syringe noma ipeni yedivayisi. Azihloselwe ukuthi zisetshenziswe njenge-agent yokuqala yokwelashwa kwelayini, kodwa izinhlobo eziningi zingasetshenziswa ngokubambisana nemithi yesifo sikashukela kanye ne-insulin therapy.
Ngokuqondile, i-GLP-1 i-agonists ye-receptor yindlela yokwelashwa okungenayo i-insulin eyaziwa kakhulu futhi evelele, eyenza indlela eya phambili ekunakekeleni nesifo sikashukela. Ucwaningo luye lwabonisa ukuthi lezi zinhlobo zemithi, uma zisetshenziselwa ukuhambisana nokudla nokuzivocavoca, kokubili okubambe isikhathi esifushane nokusebenza isikhathi eside, kungasiza iziguli ezine-type 2 zesifo sikashukela ukuba zinciphise isisindo, zinciphise i- hemoglobin A1C (isilinganiso esiyizinyanga ezintathu soshukela egazini) , njengoba kanye nokunciphisa izinga lokufa kwenhliziyo.
Ucwaningo lwamanje lubonisa ukuthi le mithi iphakeme kakhulu ekunciphiseni ushukela wegazi uma kuqhathaniswa nezinhlobo eziningi zemithi yomlomo futhi engekho ngaphansi kwezinhlawulo zokuhlanganiswa ezifana ne-basal insulin (i-insulin esebenza isikhathi eside), i-GLP-1 i-agonist ne- basal insulin , kanye ne- insulin esheshayo ngokushesha .
Zisebenza Kanjani?
Lezi zinhlobo zemithi zisebenza ngoba abantu abane-type 2 yesifo sikashukela banciphisa ukungathandwa kwe-incretin, okusho ukuthi bane-hormone encane. Enye i-incretin hormone ngokuqondile, eyaziwa ngokuthi i-peptide-glucagon-like (GLP-1), iphansi kubantu abanesifo sikashukela. I-GLP-1 ivame ukukhishwa emathunjini akho amancane uma udla, futhi isebenza ukunciphisa inqubo lapho ukudla kushiya isisu sakho, ukulawula ushukela wegazi ngemva kokudla.
Inzuzo yama-agonists ka-GLP-1 ukuthi ilingisa i-hormone ye-GLP-1 ngokubopha ku-GLP-1 receptors futhi ivuselele ukukhululwa kwe-insulini, okunciphisa ushukela wegazi. Ama-agonists e-GLP-1 enza futhi ngesisu, ubuchopho, ama-pancreas, nesibindi ukwandisa imizwa yokugcwala nokunciphisa emva kokudla ushukela wegazi , okukhuthaza ukulahlekelwa isisindo nokuthuthukisa ukuphathwa kweshukela egazini.
Ngokuvamile, azikhuthazi u-hypoglycemia ngoba zisebenza kuphela uma kune-glucose ohlelweni lwakho. Lokhu kuyinzuzo kulabo bantu abajwayele u-hypoglycemia, noma kunjalo, uma besetshenziselwa ukuhlanganiswa ne-insulini noma i-sulfonylurea ingozi ye-hypoglycemia iyanda. Uma ufuna inketho ehlukile yokuphathwa kwesifo sikashukela, khuluma nodokotela wakho ukuze uqonde kangcono uma lokhu kukhetho kulungile kuwe futhi kungakusiza ukulawula kangcono isifo sikashukela sakho.
Imiphumela emzimbeni
Ubuchopho: i- GLP-1 ithumela isignali ebuchosheni, ikakhulukazi i-hypothalamus, isitshela ukunciphisa amanzi nokudla ukudla. Ngenxa yalokho, umuntu othatha i-GLP-1 agonist uthola ngokugcwele ngokushesha. Njengoba uzizwa ugcwele ngokushesha, cishe ungadla ukudla okuncane futhi, ngenxa yalokho, ulahlekelwe isisindo. Ngenxa yokuthi ukuzwa kwakho ukuphuza kungancipha, kubalulekile ukukhumbula ukuthi uvikela ukuphelelwa amandla kwamanzi.
Isisindo: GLP-1 yandisa i-gluconeogensis emisipha. Lokhu kusiza ukwehlisa ushukela wegazi ngokukhuthaza ukutholakala kweglucose ngamangqamuzana nokwanda kwe-insulin ukuzwela (ukuthi umzimba wakho usebenzise kanjani i-insulin kahle).
I-Pancreas: I-GLP-1 ikwandisa ukucinwa kwe-insulin lapho ixhumana ne-glucose. Lokhu kusiza ukwehlisa emva kokudla ushukela wegazi. Ngaphezu kwalokho, i-GLP-1 inciphisa ukuvimba kwe-glucagon futhi ikhulise ukuvimba okuyi-somostatin. Umsebenzi we-Glucagon ukuvimbela ushukela wegazi ekuhambeni kakhulu. Kubantu abanesifo sikashukela se-type 2, i-glucagon ingakwazi ukuphakamisa amazinga e-glucose egazi kakhulu ngoba kukhona okungenayo ngokwanele i-insulin ekhona okwehlisa ushukela wegazi noma umzimba awukwazi ukuphendula i-insulin . Ngakho-ke, ngokunciphisa ukukhishwa kwe-glucagon, ushukela wegazi linciphile.
Isibindi: GLP-1 inciphisa umkhiqizo we-glucose we-hepatic (isibindi), okusiza ukwehlisa ushukela wegazi. I-GLP-1 ikhulisa i-gluconeogensis, okuyindlela enamandla yokukhiqiza i-glucose ezintweni ezingezona ama-carbohydrate, njengamaprotheni namafutha. Njengoba i-gluconeogensis iyanda, i-glucagon (i-hormone esisiza ukwandisa ushukela wegazi) ama-receptors anciphisa isibindi, avimbela ukubunjwa kwe-glucose futhi akhuthaze ukutholakala kweglucose ngamaseli okusiza ukwehlisa ushukela.
Isisu: i- GLP-1 inciphisa ukucinwa kwe-asidi futhi inciphise ukuxosha esiswini, okunciphisa ukuthi ukudla kushiya kanjani isisu sakho ngokushesha, ukwandisa ukugcwala, ukunciphisa ukuthi ushukela wegazi ophuthumayo ukhuphuka kanjani, futhi uvame ukudala isicashu. Izinga elincishisiwe lapho ukudla kushiya isisu kuphumela ekuncipheni kokudla, okuvame ukwehlisa isisindo. Ukulahlekelwa kwesisindo kunciphisa ukumelana kwe-insulin, ngaleyo ndlela kunciphisa ushukela wegazi.
Yiziphi izinhlobo ezahlukene ze-GLP-1 Agonists?
Ama-agonists e-GLP-1 angahle ahlukaniswe ngezigaba ezimbili ezihlukene: amafomula ambalwa afushane, okuvame ukukhishwa kanye noma kabili ngosuku, noma amafomula asebenza isikhathi eside, anikwa kanye ngesonto ngalinye. Uhlobo lwe-GLP-1 olutholayo luyoxhomeka emlandweni wakho wezokwelapha, umshuwalense, okuthandayo kanye nokulawulwa ushukela wegazi. Amanye ama-agonists e-GLP-1 angabiza; ngakho-ke kungengqondo ukubiza umshwalense wakho ngaphambi kokuthola imithi ukuze uqiniseke ukuthi ungakwazi ukukhokhela imithi.
Ama-Agonists aKwaseMfushane okuNcane-Kanye noma amabili OkuNgenakalunye Nsuku Zonke
Isidakamizwa: Siphelelwe yisikhathi
Igama leBrama: Byetta
I-Dose: Qala nge-5mcg kabili nsuku zonke emaminithi angu-60 ngaphambi kokudla futhi ukwandise ku-10mcg ngemva kwenyanga eyodwa.
Izithakazelo: Enye yezinhlobo ezingabizi kakhulu ze-agonists be-GLP-1, mhlawumbe ngoba sekude kakhulu.
Okungalungile: Kumelwe unikezwe amaminithi angu-60 ngaphambi kokudla okungeke kwenzeke.
Okunye okucatshangelwayo: I-Byetta idutshulwe ngezinso futhi ayinconywa kubantu abane-GFR abangama-30 noma ngaphansi.
Imithi: Liraglutide
Igama lomgqa: Victoza
I-Dose: 0.6mcg isonto elilodwa bese ukwandisa umthamo ukuya ku-1.2mcg. Uma ushukela wegazi usemgomeni, ungagcina leli dose, noma ukwandise ube ngu-1.8mcg njengokubekezela. Udokotela wakho kufanele akululeke ngendlela yokwandisa umthamo.
Okuhle: Kuye kwafakazelwa ukuthi kunikezwa isisindo esiningi kakhulu.
Okubi: Kumelwe unikezwe kanye nsuku zonke. Iziguli zibika isimo esiphezulu sezinyosi, okungenzeka ukuthi kungani kunesisindo esiningi kakhulu.
Imithi: Lixisenatide
Igama lomdaka: i-Adlyxin
I-Dose: 10 mcg nsuku zonke amasonto amabili bese ukwandisa kube yi-20 mcg nsuku zonke.
Izithakazelo: Kunokusebenza okufanayo njenge-Byetta.
Okungalungile: Kumele kukhishwe njalo imizuzu engama-60 ngaphambi kokudla kokuqala kosuku
Okunye okucatshangelwayo: Ingabe i-excreted ngezinso futhi kufanele igwenywe nge-GFR
I-Long Acting i-GLP-1 Agonist - Kanye Kanye Nesifo Esinjengabasonto
Isidakamizwa: Siphakamisa ifomu elidala elibamba le-Byetta
Igama loBrithani : Bydureon (enqunywe njenge-vial enekiti noma ipeni)
Dose: 2mg ngesonto onke, unikezwe kanye ngesonto.
Ukunciphisa i-A1C: Mayelana namaphesenti angu-1.3.
Izithakazelo: Zinikezwe kanye ngesonto; ingahle ibhalwe nge-pen.
Ama-Negatives: Ingabe ukuhlaziywa ngokweqile kukhishwe futhi kufanele kugwenywe nge-GFR engu-30 noma ngaphansi. Ngaphezu kwalokho, i-gauge yenaliti ibanzi (23G).
Okunye okucatshangelwayo: Ucwaningo luye lwabonisa ukuthi luphansi kune-Victoza mayelana nokunciphisa i-A1C futhi kungaba nzima uma ukuhlolwa (kufanele kuhlanganiswe). Ngaphezu kwalokho, abantu abaningi bakhononda ukuphendula kwesayithi lapho umuthi ujova khona.
Imithi: Dulaglitide
Igama logama: I-Trulicity (ipeni)
I-Dose: Qala nge-0.75mg ngesonto onke bese ukwandisa kuya ku-1.5mg emavikini ayisithupha ukuya kwangu-8.
Ukunciphisa i-A1C: Mayelana namaphesenti angu-1.4.
Izithako: Akudingeki ukuthi zixutshwe ngesandla. Akudingeki ukuthi unamathisele inaliti futhi ungayiphonsa ipeni lonke esitsheni sesibhamu ngemuva kokuthi uhambise umthamo. Idayiswa kanye ngesonto futhi inciphisa e-A1C ephakeme kune-Victoza.
Izinga elibi: Akuhlanganiswa yizo zonke izinkampani ezikhokhelwa futhi zingabiza.
Yiziphi Imiphumela Ezingezansi?
- Umphumela ovame kakhulu ohlangothini lwe-GLP-1 agonists uyisicefe, ukuhlanza nokuhuda. Lokhu kwenzeka ngamaphesenti angaba ngu-10 ukuya ku-40 (kuye ngokuthi imithi ethile) yabantu futhi ivame kakhulu kuma-agent abambalwa abenzayo. Kodwa-ke, lemiphumela emibi ivame ukunciphisa njengoba umuntu ekhona emithini isikhathi eside. Ngaphezu kwalokho, uma uthatha u-GLP-1 omfushane owenza i-GLP-1, njengo-Victoza, ukuthatha ngaphambi kombhede kungasiza ekunciphiseni isicanucanu.
- Ucwaningo oluye lwaqhutshwa ngamagundane lubonisa ukuthi ezinye ze-agonists ze-GLP-1, ikakhulukazi i-liraglutide ne-dulaglutide, zingakhuthaza izicubu ze-thyroid cell. Nakuba lezi zifundo zingakaze zenziwe kubantu, kunconywa ukuthi labo bantu abanomlando noma umlando womndeni we-medullary umdlavuza we-thyroid kanye ne-Multiple Endocrine Neoplasia hlobo 2 abasebenzisi i-GLP-1 agonsists.
- Ngama-agonists athile ka-GLP-1 kukhona ingozi encane engakhulayo yokunyuka kwe-pancreatitis (ukuvuvukala kwama-pancreas).
- Abantu bangakwazi ukuthola ukusizwa kwendawo yomjovo lapho imithi ifakwa khona.
Ngubani okufanele agweme lezi zinhlobo zemithi?
Le mithi ayinconywa uma:
- unomlando we-pancreatitis.
- unomlando we-gastroparesis (ukukhubazeka kwesisu).
- unomlando noma umlando womndeni we-medullary umdlavuza wegciwane noma abantu abaningi abakwa-Endocrine Neoplasia hlobo 2.
Futhi, abantu abanesifo sikashukela abanomsebenzi wezinso wehlile, nge-GFR (izinga lokuhlunga kwe-glomerular) noma 30 noma ngaphansi akufanele basebenzise i-bydureon ne-byetta. Xoxa nge-renal dosing nodokotela wakho uma uthatha amanye ama-agonists e-GLP-1.
Akukho ubufakazi obanele bokusekela ukuphepha kuziguli ezise-dialysis, ngakho-ke ukugwema ukusetshenziswa kwe-GLP-1 kulesi sabantu kuhlakaniphile.
Kuyini Okulandelayo?
Njengoba imishanguzo yesifo sikashukela iqhubeka ukuvela futhi ucwaningo luqhubeka ngokushesha ukuze luvikeleke, lube lula futhi luphumelele izinhlobo ze-GLP-1 agonists, siqinisekile ukuthi sizobona imithi eminingi esikhathini esizayo. Eqinisweni, enye i-agonist ye-GLP-1 okwamanje isebenzisa ukugunyazwa kwe-FDA, i-semaglutide, kuthiwa ukunciphisa izingozi zenhliziyo ngamaphesenti angu-26. Futhi njengebhonasi, i-semaglutide yomlomo isesimweni sesivivinyo sesi-II, okusho ukuthi ngelinye ilanga, ama-agonists a-GLP-1 angeke adinge ukujovwa.
> Imithombo:
> Dungan, K, DeSantis, A. I-peptide-like peptide 1 i-receptor agonists yokwelapha uhlobo lwe-2 lwesifo sikashukela. Kusesikhathini.
> I-Vishal, i-Gupta. Ama-analogues anjenge-peptide-1 afana ne-Glucagon: Ukubuka konke. I-Indian J Endocrinol Metab. 2013 Meyi-Juni, 17 (3): 413-421.
> Smilowitz, N, Donnino, uRobert, Schwartzbard, u-Arthur. I-Glucagon-efana ne-peptide receptor agonists ye-diabetes: Inendima yesifo senhliziyo. Ukujikeleza.