ANÁLISE COMPARATIVA DO USO DE INIBIDORES DA ALFA-GLUCOSIDASE E DE INIBIDORES DA DPP-4 NO TRATAMENTO DA DIABETES TIPO 2

Considering the growing impact of type 2 diabetes on global public health, there is a justified need to explore effective therapeutic approaches. This study aimed to conduct a comparative analysis between alpha-glucosidase inhibitors and DPP-4 inhibitors, both used in the management of type 2 diabetes. To this end, a qualitative bibliographic review was conducted, covering multiple languages, using databases such as Scielo, Google Scholar, scientific journals, repositories, and virtual libraries. Inclusion and exclusion criteria were applied to select relevant studies that addressed the efficacy, side effects, mechanisms of action, and impact on glycemic control of these inhibitors. It was observed that DPP-4 inhibitors, such as Sitagliptin and Saxagliptin, are effective in reducing fasting glucose and glycated hemoglobin (HbA1C), in addition to presenting a favorable safety profile. On the other hand, alpha-glucosidase inhibitors, such as Acarbose, stand out in reducing postprandial glucose but are frequently associated with adverse gastrointestinal effects such as flatulence and diarrhea. It is concluded that both classes of drugs have their specific advantages, with DPP-4 inhibitors being more effective in reducing HbA1C and better tolerated, while alpha-glucosidase inhibitors are particularly useful for controlling postprandial glucose. The choice of treatment should be individualized, considering the efficacy, tolerability, and specific needs of patients. Future studies may explore therapeutic combinations to maximize benefits and minimize adverse effects, as well as investigate treatments based on genetic characteristics and specific biomarkers for a more personalized management of type 2 diabetes.Considerando o crescente impacto da diabetes tipo 2 na saúde pública global, justifica-se a necessidade de explorar abordagens terapêuticas eficazes. Este estudo objetivou realizar uma análise comparativa entre inibidores da alfa-glucosidase e inibidores da DPP-4, ambos utilizados no manejo da diabetes tipo 2. Para tanto, procedeu-se a uma revisão bibliográfica qualitativa, abrangendo múltiplos idiomas, utilizando bases de dados como Scielo, Google Acadêmico, revistas científicas, repositórios e bibliotecas virtuais. Critérios de inclusão e exclusão foram aplicados para selecionar estudos relevantes que abordassem a eficácia, efeitos colaterais, mecanismos de ação e impacto no controle glicêmico desses inibidores. Observou-se que os inibidores da DPP-4, como Sitagliptina e Saxagliptina, são eficazes na redução da glicemia de jejum e na hemoglobina glicada (HbA1C), além de apresentarem um perfil de segurança favorável. Por outro lado, os inibidores da alfa-glucosidase, como a Acarbose, destacam-se na redução da glicemia pós-prandial, mas são frequentemente associados a efeitos gastrointestinais adversos, como flatulência e diarreia. Conclui-se que ambas as classes de medicamentos têm suas vantagens específicas, sendo os inibidores da DPP-4 mais eficazes na redução da HbA1C e melhor tolerados, enquanto os inibidores da alfa-glucosidase são particularmente úteis para controlar a glicemia pós-prandial. A escolha do tratamento deve ser individualizada, considerando a eficácia, a tolerabilidade e as necessidades específicas dos pacientes. Estudos futuros podem explorar combinações terapêuticas para maximizar os benefícios e minimizar os efeitos adversos, bem como investigar tratamentos baseados em características genéticas e biomarcadores específicos para um manejo mais personalizado da diabetes tipo 2. &nbsp

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups

Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups. Trial registration number NCT0432364