Access restricted to higher education institution's students and staff
master's thesis
Novosti u terapijskom pristupu pretilim dijabetičarima

Vesna Zarezovski (2015)
Metadata
TitleNovosti u terapijskom pristupu pretilim dijabetičarima
AuthorVesna Zarezovski
Mentor(s)Sanja Klobučar Majanović (thesis advisor)
Abstract
Pretilost je rastući javnozdravstveni problem jer se broj pretilih osoba rapidno povećava na globalnoj razini. Paralelno s epidemijom pretilosti suočeni smo s rastućom epidemijom šećerne bolesti tipa 2. Postoje mnoga istraživanja na temu pretilosti i šećerne bolesti tipa 2 koji nepobitno dokazuju snažnu vezu između ta dva poremećaja. Pretilost izaziva inzulinsku rezistenciju u perifernim tkivima što dovodi do prekomjerne sekrecije inzulina kako bi se navedena rezistencija prevladala i u konačnici rezultira disfunkcijom beta stanice gušterače. Stoga je od izuzetne važnosti spriječiti razvoj pretilosti od najranije dječje dobi, a u osoba koju su već pretile poduzeti sve mjere liječenja s ciljem gubitka tjelesne težine i prevencije komplikacija debljine, uključujući i šećernu bolest tip 2. Naglasak je pri tome na uravnoteženoj prehrani, smanjenom kalorijskom unosu i primjernoj tjelesnoj aktivnosti. U osoba koje su već razvile dijabetes voljni gubitak prekomjerne tjelesne mase doprinosi boljoj kontroli glikemije, a time i odgađanju razvoja dijabetičkih komplikacija. U tom smislu izuzetno je važno i pri odabiru lijekova za kontrolu glikemije birati one koje djeluju povoljno na tjelesnu težinu. Problem predstavlja činjenica da neki oralni antidijabetici, posebice derivati sulfonilureje starije generacije, derivati benzojeve kiseline te inzulin dovode do porasta tjelesne težine. Prekomjerna akumulacija masnog tkiva povećava inzulinsku rezistenciju što pogoršava regulaciju glikemije i iziskuje povećanje doze postojećih ili uvođenje dodatnih antidijabetika. Otkriće i primjena lijekova koji svoj učinak temelje na inkretinskom efektu (DPP-4 inhibitori, GLP-1 analozi) predstavlja iskorak u liječenju šećerne bolesti tipa 2 zbog toga što povrh učnika na glikemiju oni imaju i povoljan učinak na tjelesnu težinu i povoljan sigurnosni profil s naglaskom na odsustvo hipoglikemija. I najnovija skupina oralnih antidijabetika, SGLT2 inhibitori koji svoj učinak ostvaruju putem bubrega potičući glukozuriju također predstavljaju dobar terapijski izbor za pretile dijabetičare. Metabolička kirurgija je danas jasno pozicionirana u smjernicama za liječenje osoba sa šećernom bolesti tip 2 naglašavajući da kirurgija može biti opcija i za bolesnike s nižim stupnjevima debljine. No, niti jedna terapijska opcija neće dati željene rezultate bez motiviranosti i suradljivosti bolesnika.
KeywordsObesity Diabetes Mellitus Type 2 Therapy
GranterSveučilište u Rijeci
Medicinski fakultet
Lower level organizational unitsKatedra za internu medicinu
PlaceRijeka
StateCroatia
Scientific field, discipline, subdisciplineBIOMEDICINE AND HEALTHCARE
Clinical Medical Sciences
Internal Medicine
Study programme typeuniversity
Study levelintegrated undergraduate and graduate
Study programmeMedicine
Academic title abbreviationdr. med.
Genremaster's thesis
Language Croatian
Defense date2015
Parallel abstract (English)
Obesity is a growing public health problem because the number of overweight people is rapidly increasing globally. In parallel with the obesity epidemic, we are faced with a growing epidemic of type 2 diabetes There are many studies on the subject of obesity and type 2 diabetes, which conclusively prove a strong link between the two disorders. Obesity causes insulin resistance in peripheral tissues, leading to excessive secretion of insulin in order to overcome resistance and ultimately resulting in dysfunction of the beta cells of the pancreas. Therefore, it is extremely important to prevent the development of obesity from early childhood, and people that are already threatened to take all measures of treatment with the goal of losing weight and preventing complications of obesity, including diabetes type 2. The emphasis is on balanced diet, reduced calorie entry and adequate physical activity. In people who have already developed diabetes willing to lose excess weight contributes to better control of glycemia, and delaying the development of diabetic complications. In this respect, it is important in the selection of medicaments for the control of glycaemia choose those that act favorably on the body weight. The problem is the fact that some oral hypoglycaemic drugs, especially the older generation of sulfonylurea derivatives, benzoic acid derivatives of insulin are leading to weight gain. Excessive accumulation of body fat increases insulin resistance which worsens glycemic control and requires increasing doses of existing or introduction of additional antidiabetic agents. The discovery and application of medications that their performance based on the incretin effect (DPP-4 inhibitors, GLP-1 analogues) represents a breakthrough in the treatment of type 2 diabetes because of pupils in addition to glycemia and they have a beneficial effect on body weight and a favorable safety profile with emphasis on the absence of hypoglycemia. And the latest group of antidiabetic drugs, SGLT2 inhibitors, which have their effect through the kidneys encouraging glycosuria also represent a good therapeutic option for obese diabetics. Metabolic surgery is now clearly positioned in the guidelines for the treatment of diabetes patients with type 2 emphasizing that surgery may be an option for patients with lower levels of obesity. However, neither of these therapeutic options can't produce the desired results without patient motivation and compliance.
Parallel keywords (Croatian)pretilost šećerna bolest terapija
Resource typetext
Access conditionAccess restricted to higher education institution's students and staff
Terms of usehttp://rightsstatements.org/vocab/InC/1.0/
URN:NBNhttps://urn.nsk.hr/urn:nbn:hr:184:035857
CommitterBosa Licul