Vnitr Lek 2020, 66(Suppl.A):4-6 | DOI: 10.36290/vnl.2020.128

Jak postupovat v boji s inzulinovou rezistencí u pacientů s DM 2. typu

prof. MUDr. Martin Haluzík, DrSc.
Centrum diabetologie, IKEM

Prof. Haluzík se ve své přenášce věnoval možnostem přínosného využití jednoho z méně využívaných antidiabetik - pioglitazonu. Připomněl, že jde o jediné antidiabetikum, které přímo ovlivňuje inzulinovou rezistenci. Inzulinová rezistence je přitom jedním ze dvou základních patogenetických mechanismů diabetu 2. typu uplatňující se zejména v počátečních stadiích. Jak uvedl, pioglitazon se proto dá velmi dobře použít u diabetiků s metabolickým syndromem a na základě výsledků studie IRIS také u diabetiků po cévní mozkové příhodě (CMP). Vhodný je do kombinace s GLP-1 RA nebo s inhibitory SGLT2, které potlačí některé jeho nežádoucí účinky, jako je nárůst hmotnosti nebo retence tekutin. Kromě toho má pioglitazon prokázaný kardiovaskulární (KV) přínos. Ve studii ProActive v porovnání s placebem významně snížil výskyt složeného cílového ukazatele zahrnujícího celkovou mortalitu, nefatální infarkt myokardu nebo CMP o 16 %, což je výsledek srovnatelný s výsledky CVOT s nejnovějšími antidiabetiky (GLP-1 RA a SGLT2i). Pioglitazon by si proto zasloužil významnější místo v rozhodovacím algoritmu volby antidiabetické léčby v mezinárodních doporučeních a měl by být častěji využíván u vhodných pacientů s diabetem 2. typu, a to již v časných stadiích onemocnění.

Published: November 5, 2020  Show citation

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Haluzík M. Jak postupovat v boji s inzulinovou rezistencí u pacientů s DM 2. typu. Vnitr Lek. 2020;66(Suppl. A / Zaznělo na ):4-6. doi: 10.36290/vnl.2020.128.
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