Uluphi uhlobo lweMithi lunganceda ukuLawula isifo sikashukela
Izilwanyana ezingenayo i-insulin luhlobo lonyango olufakwe ngaphakathi ngaphantsi kwiisisitye ezinamafutha nge-sringe okanye ipowuni. Azinakulingelwa ukuba zisetyenziswe njenge-arhente yokuqala yonyango, kodwa ezininzi iintlobo zingasetyenziselwa ukudibanisa namachiza omlomo we-diabetes kunye ne-insulin yonyango.
Ngokukodwa, i-GLP-1 i-agonists ye-receptor yimihlobo ye-non-insulin yonyango ejoyiweyo eqhubeka ngokugqithisekayo kwaye evelele, eyenza indlela yayo ibe yindlela ephambili yokunyamekela ngoshukela kunye nophando. Ucwaningo luye lwabonisa ukuba ezi ntlobo zamachiza, xa zisetyenziselwa ukudibanisa nokutya kunye nokuzilolonga, kokubambisana okufutshane kunye nokusebenza kwexesha elide, kunokunceda izigulane zolu hlobo lwesifo sikashukela zinciphise umzimba, zinciphise i- hemoglobin A1C (i-average average month of their blood sugar) , njengoko kunye nokunciphisa izinga lokufa kwentliziyo.
Uphando lwangoku lubonisa ukuba la mayeza aphezulu ekunciphiseni ushukela wegazi xa kuthelekiswa neentlobo ezininzi ezahlukeneyo zamachiza omlomo kwaye azikho ngaphantsi kwama-regimens enxulumene ne-basal insulin (i-insulin esebenza ixesha elide), kunye ne-GLP-1 ye-agonist ngokubhekiselele kwi -insulin ye-basal , kunye ne- insulin esebenza ngokukhawuleza. .
Ba sebenza Njani?
Ezi ntlobo zonyango zisebenza ngenxa yokuba abantu abanesifo sikashukela bahlobo lwe-2 banokuhla kwe-incretin, oku kuthetha ukuba banama-hormone angaphantsi. Enye i-incretin hormone ngokukhethekileyo, eyaziwa ngokuba yi-glucagon-like peptide (GLP-1), iphantsi kubantu abanesifo sikashukela. I-GLP-1 idla ngokukhululeka kumathumbu akho amancinci xa udla, kwaye isebenza ekunciphiseni inkqubo apho ukutya kushiya isisu sakho, ukulawula ishukela legazi emva kokutya.
Inzuzo ye-GLP-1 agonists kukuba bafanisa i-hormone ye-GLP-1 ngokubopha kwi-GLP-1 receptors kunye nokukhuthaza ukukhululwa kwe-insulin, okunciphisa ushukela wegazi. I-GLP-1 i-agonists iphinda isebenze esiswini, ingqondo, i-pancreas, nesibindi ukunyusa iimvakalelo zokuzaliseka kunye nokunciphisa emva kokutya kwegazi , okukhuthaza ukulahleka kwesisindo nokuphucula ukuphathwa kweswekile.
Ngokuqhelekileyo, abakhuthazi u-hypoglycemia kuba ba sebenza kuphela xa kukho i-glucose kwindlela yakho. Le yinzuzo kulabo bantu abaxhomekeke kwi-hypoglycemia, nangona kunjalo, xa besetyenziselwa ukudibanisa ne-insulin okanye i-sulfonylurea umngcipheko we-hypoglycemia ukwanda. Ukuba ukhangele inketho eyahlukileyo yokulawula isifo sikashukela, xela ugqirha ukuba uqonde ngakumbi ukuba olu khetho lukulungele kwaye luyakunceda ukuba ulungele ukulawula isifo sikashukela.
Iziphumo kwiBhunga
Ubungqingili: I-GLP-1 ithumela umqondiso kwingqondo, ngokukodwa i-hypothalamus, ixelela ukuba ukunciphisa amanzi kunye nokutya kokutya. Ngenxa yoko, umntu othatha i-agonist ye-GLP-1 ufumana ngokukhawuleza ngokukhawuleza. Njengoko uvakalelwa ngokukhawuleza ngokukhawuleza, unokutya ukutya okungaphantsi kwaye, ngenxa yoko, ulahlekelwe isisindo. Ngenxa yokuba uvakalelo lwakho ukusela lingancipha, kubalulekile ukuba ukhumbule ukukhusela ukukhulelwa kwamanzi.
I-Muscle: GLP-1 yandisa i-gluconeogensis kwisisipha. Oku kunceda ukunciphisa iishukela zegazi ngokukhuthaza i-glucose ukufunyanwa ngamaseli kunye nokwanda kwe-insulin (ukuba umzimba wakho usebenzise njani i-insulin).
Iipancreas: I-GLP-1 ikhulisa ukugcinwa kwe-insulin xa idibene ne-glucose. Oku kunceda ukunciphisa emva kokutya kwegazi. Ukongeza, i-GLP-1 iyanciphisa ukugcinwa kweglucagon kunye nokwandisa ukugcinwa kwe-somostatin. Umsebenzi weGlucagon ukukhusela iishukela zegazi ekuhlaleni. Kubantu abanesifo sikashukela se-type 2, i-glucagon inokuphakamisa amanqanaba e-glucose egazi kakhulu ngenxa yokuba akukho nangoko i-insulin ekhoyo kwintshukela yegazi ephantsi okanye umzimba awukwazi ukuphendula kwi-insulin . Ngenxa yoko, ngokunciphisa i-glucagon, i-sugar sugar is reduced.
Ibindi: I-GLP-1 iyanciphisa i-hepatic (isibindi) i-glucose output, eyanceda ukunciphisa ushukela wegazi. I-GLP-1 ikhulisa i-gluconeogensis, yindlela ehamba ngayo yokuvelisa i-glucose kwizinto ezingekho i-carbohydrate, njengeprotheni kunye namafutha. Njengoko i-gluconeogensis iyanda, i-glucagon (i-hormone enceda ukwandisa ushukela wegazi) i-receptors iyancitshiswa esibindi, ikhubaza i-glucose form and ivuselela i-glucose ukufunyanwa ngamaseli anceda ukunciphisa ishukela.
Isisu: i- GLP-1 iyanciphisa ukukhutshwa kwe-acid kwaye iyanciphisa ukukhupha isisu, esinciphisa ngokukhawuleza ukutya okushiya isisu sakho, ukwandisa ukugcwala, ukunciphisa ukukhawuleza kwe-sugar sugars, kwaye ngokuqhelekileyo kubangele i-nudea. Izinga elincinci apho ukutya kushiya isisu kuphumela ekunciphiseni kokutya, okwenza kube lula ukulahleka. Ukulahlekelwa kwesisindo kunciphisa ukunganyangeki kwe-insulin, oko kukunciphisa ushukela wegazi.
Ziziphi iintlobo ezahlukeneyo ze-GLP-1 Agonists?
I-GLP-1 i-agonists inokuphulwa kwiindidi ezimbini ezihlukeneyo: iifomula ezimfutshane ezenza iifomula, ezifakwe ngokuphindwe kabini okanye kabini ngosuku, okanye amafomula athatha ixesha elide, anikwa kanye ngeveki. Uhlobo lwe-GLP-1 oyifumayo luya kuxhomekeka kwimbali yakho yonyango, i-inshorensi, ukukhetha kwakho kunye nokulawula ishukela egazini. Ezinye i-GLP-1 agonists zinokubiza; Ngako oko kungengqiqo ukubiza i-inshurensi ngaphambi kokuba ufumane imithi yokuqinisekisa ukuba unokufumana iyeza.
I-Short Acting GLP-1 Agonists - Kanye okanye Ngamaxesha Aphindayo kabini
Iziyobisi: Ukugqithisa
Igama leBrama: Byetta
I-Dose: Qala nge-5mcg kabini imihla ngemizuzu engama-60 ngaphambi kokutya kwaye ukhuphuke ukuya kwi-10mcg emva kwenyanga enye.
Izithuba: Enye yeendleko ezincinci ze-GLP-1 agonists, mhlawumbi ngenxa yokuba sele lide lide.
Ukungalungi: Kumele unikezwe imizuzu engama-60 ngaphambi kokutya okungekho nto.
Ezinye iingqwalasela: I-Byetta idityaniswe ngeentso kwaye ayikhuthazwa kubantu abane-GFR abangama-30 okanye ngaphantsi.
Iziyobisi: iLiraglutide
Igama leBrama: Victoza
I-Dose: 0.6mcg iveki enye kwaye ukwandisa umthamo ukuya kwi-1.2mcg. Ukuba iishukela zegazi zisesigxina, unako ukugcina le dose, okanye ukwandisa ukuya kwi-1.8mcg njengokuba unyamezelekile. Ugqirha wakho kufuneka akucebise malunga nendlela yokwandisa umthamo.
Okulungileyo: Kuye kwabonakaliswa ukubonelela ngokulahlekelwa ubunzima.
Ukungalungi: Kufuneka unikezwe rhoqo ngosuku. Izigulane zibika iziganeko eziphezulu zesohlwayo, mhlawumbi kutheni kukho ukulahleka okuninzi.
Iziyobisi: Lixisenatide
Igama leBrama: i-Adlyxin
I-Dose: 10 i-mcg nganye kwiiveki ezimbini kwaye ukwandisa ukuya kwi-20 mcg imihla ngemihla.
Izithuba: Unokusebenza ngendlela efanayo ne-Byetta.
Iimpawu ezimbi: Kumele zihlulwe imihla ngemizuzu engama-60 ngaphambi kwesidlo sokuqala sosuku
Ezinye iinkalo: Ngaba zikhutshwe ngeenso kwaye zifanele zigwenywe ngeGFR
I-Agingist GLP-1 ende-Emva kweVeki nganye
Iziyobisi: Ukugqithisa ixesha elide lokubamba i-Byetta
Igama leBrama: i- Bydureon (echazwe njengevali enekiti okanye ipeni)
I-Dose: 2mg ngeveki nganye, enikwa kanye ngeveki.
Ukunciphisa i-A1C: malunga neepesenti ezingama-1.3.
Izithuba: Unikwa kanye ngeveki; inokumiselwa nge pen.
Iingxaki: Ngaba i-renally yenziwe ikhutshwe kwaye kufuneka igwenywe nge-30 ye-GFR okanye ngaphantsi. Ukongezelela, umlinganiselo wesaliti unzima (23G).
Ezinye iingcamango: Izifundo zibonise ukuba zingaphantsi kwe-Victoza ngokubhekiselele ekunciphiseni i-A1C kwaye ingaba nzima xa u-dosing (kufuneka uxutywe). Ukongezelela, abaninzi abantu bayakhalaza izimpendulo zendawo apho ijojoza ifakwe khona.
Iziyobisi: iDulaglitide
Igama leBrama: iTrulicity (ipen)
I-Dose: Qala nge 0.75mg ngeveki kunye nokwandisa ukuya kwi-1.5mg kwiiveki ezi-6 ukuya kwezi-8.
Ukunciphisa i-A1C: malunga ne-1.4 ekhulwini.
Izithuba: Akufuneki ukuba zixutywe ngesandla. Akunakufuneka unamathele inaliti kwaye ungayiphonsa ipenki yonke kwisibhozo sokutsala emva kokuba uhambise i dose. Yayihlanjululwa kanye ngeveki kwaye iyanciphisa i-A1C ngaphezu kwe-Victoza.
Iingxaki: Azinakutyhulwa yizo zonke iintlawulo kwaye zingabiza.
Ziziphi iimpembelelo?
- Umphumo oqhelekileyo ochaphazelekayo we-GLP-1 agonists uyisicasuliso, ukuhlanza kunye nesifo sohudo. Oku kwenzeka kumaphesenti angama-10 ukuya kuma-40 (kuxhomekeke kumachiza athile) kunye nabantu abaqhelekileyo kwii-agents ezifutshane. Nangona kunjalo, ezi ziphumo zempembelelo zivame ukunciphisa njengoko umntu ekhona kwiyeza ixesha elide. Ukongeza, ukuba uthabatha i-GLP-1 emfutshane, njenge-Victoza, ukuyithatha ngaphambi kokulala kungakunceda ukunciphisa isicupunu.
- Izifundo eziye zenziwa kwiigorants zibonisa ukuba ezinye i-GLP-1 agonists, ngokukodwa i-liraglutide kunye ne-dulaglutide, zinokukhuthaza i-tumors cell cell. Nangona ezi zifundo zingakhange ziqhutyelwe kubantu, kuyacetyiswa ukuba abo bantu abaneembali okanye imbali yentsapho ye-medullary umdlavuza we-thyroid kunye ne-Multi-End Endine-neoplasia hlobo 2 abasebenzisi i-GLP-1 agonsists.
- Ngezinye ii-agonists ezithile ze-GLP-1 kukho ubuncinci obunciphekileyo bokunyuka kwe-pancreatitis (ukuvuvukala kwe-pancreas).
- Abantu banokufumana iimpendulo zendawo yejoyi apho kufakwa khona iyeza.
Ngubani Omele Aphephe Le Ndidi Zamachiza?
Eli nyanga alicebisi ukuba:
- unembali ye-pancreatitis.
- unembali yegastroparesis (ukukhubazeka kwesisu).
- Unembali okanye yentsapho yembali yomdlavuza we-thyroid okanye abaninzi abantu abane-Endocrine Neoplasia hlobo 2.
Kwakhona, abantu abanesifo sikashukela abaye baphantsi kwemisebenzi yeentso, kunye ne-GFR (izinga lokuhlanjululwa kwe-glomerular) okanye 30 okanye ngaphantsi akufanele ukusebenzisa i-bydureon kunye ne-byetta. Xoxa nge-renal dosing kunye nodokotela wakho ukuba uthatha ezinye i-GLP-1 agonists.
Akukho ubungqina obaneleyo bokuxhasa ukhuseleko kwizigulane ezise-dialysis, ngoko ke ukuphepha ukusetyenziswa kwe-GLP-1 kule ndawo kubulumko.
Yintoni elandelayo?
Njengoko amayeza enesifo sikashukela ayaqhubeka kwaye uphando luqhubela phambili ngokukhawuleza ukuba lube lukhuselekileyo, luncedo ngakumbi, kwaye luyimpumelelo yeentlobo ze-AGP-1 agonists, siyaqiniseka ukuba sibona amayeza amaninzi ezayo kwixesha elizayo. Enyanisweni, enye i-agonist ye-GLP-1 okwangoku ifake isicelo sokugunyazwa kwe-FDA, i-semaglutide, kuthiwa ukunciphisa ingozi yengqondo ngama-26 ekhulwini. Kwaye njengebhonasi, i-semaglutide yomlomo isesilingo sesigaba II, oko kuthetha ngolunye usuku, ii-agonists ze-GLP-1 ayifuni ukuba zijojowe.
> Imithombo:
> Dungan, K, DeSantis, A. I-peptide efana ne-glucagon 1 i-receptor agonists yokunyanga uhlobo lwesifo sikashukela se-2. Isemgangathweno.
> Vishal, Gupta. I-Glucagon-efana ne-peptide-1 efana: Uhlolo-mpendulo. Indian J Endocrinol Metab. Ngo-2013 ngoMeyi-Juni, 17 (3): 413-421.
> Smilowitz, N, Donnino, uRobert, Schwartzbard, uArthur. I-glucagon-njenge-peptide receptor agonists yesifo sikashukela: Inendima kwisifo senhliziyo. Ukuhamba.