Pharmacology and therapeutic implications of current drugs for type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a global epidemic that poses a major challenge to health-care systems. Improving metabolic control to approach normal glycaemia (where practical) greatly benefits long-term prognoses and justifies early, effective, sustained and safety-conscious intervention. Improvements in the understanding of the complex pathogenesis of T2DM have underpinned the development of glucose-lowering therapies with complementary mechanisms of action, which have expanded treatment options and facilitated individualized management strategies. Over the past decade, several new classes of glucose-lowering agents have been licensed, including glucagon-like peptide 1 receptor (GLP-1R) agonists, dipeptidyl peptidase 4 (DPP-4) inhibitors and sodium/glucose cotransporter 2 (SGLT2) inhibitors. These agents can be used individually or in combination with well-established treatments such as biguanides, sulfonylureas and thiazolidinediones. Although novel agents have potential advantages including low risk of hypoglycaemia and help with weight control, long-term safety has yet to be established. In this Review, we assess the pharmacokinetics, pharmacodynamics and safety profiles, including cardiovascular safety, of currently available therapies for management of hyperglycaemia in patients with T2DM within the context of disease pathogenesis and natural history. In addition, we briefly describe treatment algorithms for patients with T2DM and lessons from present therapies to inform the development of future therapies

Traditional dietary pattern of South America is linked to breast cancer: an ongoing case-control study in Argentina

Introduction Several studies have shown the effect of dietary patterns on breast cancer risk, but none has been conducted in Argentina. The aim of this study was to extract dietary patterns from Food Frequency Questioner, to estimate their effect on breast cancer occurrence while taking into account aggregation factors (family history of breast cancer) and to explore the sensitivity of the estimates to changes in the assumptions. Methods A principal component exploratory factor analysis was applied to identify dietary patterns, which were then included as covariates in a multilevel logistic regression. Family history of BC was considered as a clustering variable. A multiple probabilistic sensitivity analysis was also performed. Results The study included 100 cases and 294 controls. Four dietary patterns were identified. Traditional (fat meats, bakery products, and vegetable oil and mayonnaise) (OR III tertile vs I 3.13, 95 % CI 2.58?3.78), Rural (processed meat) (OR III tertile vs I 2.02, 95 % CI 1.21?3.37) and Starchy (refined grains) (OR III tertile vs I 1.82, 95 % CI 1.18?2.79) dietary patterns were positively associated with BC risk, whereas the Prudent pattern (fruit and non-starchy vegetables) (OR III tertile vs I 0.56, 95 % CI 0.41?0.77) showed a protective effect. For Traditional pattern, the median bias-adjusted ORs (3.52) were higher than the conventional (2.76). Conclusions While the Prudent pattern was associated with a reduced risk of BC, Traditional, Rural and Starchy patterns showed a promoting effect. Despite the threats to validity, the nature of associations was not strongly affected.Fil: Tumas, Natalia. Universidad Nacional de Cordoba. Facultad de Medicina. Escuela de Nutricion. Cat.de Estadistica y Bioestasdística; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Córdoba. Centro de Investigaciones y Estudio sobre Cultura y Sociedad; ArgentinaFil: Niclis, Camila. Universidad Nacional de Cordoba. Facultad de Medicina. Escuela de Nutricion. Cat.de Estadistica y Bioestasdística; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Aballay, Laura. Universidad Nacional de Cordoba. Facultad de Medicina. Escuela de Nutricion. Cat.de Estadistica y Bioestasdística; ArgentinaFil: Osella, Alberto. Laboratorio di Epidemiologia E Biostatistica; ItaliaFil: Diaz, María del Pilar. Universidad Nacional de Cordoba. Facultad de Medicina. Escuela de Nutricion. Cat.de Estadistica y Bioestasdística; Argentin

Pre-pregnancy and pregnancy predictors of obesity.

Obesity has progressively become a global epidemic that constitutes one of the biggest current health problems worldwide. Pregnancy is a risk factor for excessive weight gain. Factors that may predict development of obesity in later life mainly include gestational weight gain, pre-pregnancy nutritional status, age, parity and race. Change in lifestyle factors, such as eating habits, enrollment in physical activity, smoking and duration of lactation, in addition to the above factors, may also contribute to the development of obesity but are still not fully understood. Women who retain more body weight after pregnancy have, in general, larger pregnancy body weight gain, higher pre-pregnancy body mass index, marked weight changes in previous pregnancies, lactate slightly less and stop smoking during pregnancy to a larger extent. In addition, irregular eating habits and decreased leisure time activity after delivery influence postpartum weight retention. Taking into consideration the epidemic of obesity, with all its adverse long-term consequences, there is an increasing need to promote counseling before, during and after pregnancy on the role of diet and physical activity in reproductive health