Author/Editor		Medvešček, Marko
Title		Prandialna regulacija glikemije: nov način zdravljenja sladkorne bolezni tipa 2
Translated title		Prandial glucose regulation: new approach to the treatment of type 2 diabetes
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 68, št. 6
Publication year		1999
Volume		str. 379-82
Language		slo
Abstract		Background. The pancreatic beta-cell of a type 2 diabetic is incapable of responding to the elevated blood glu- coseconcentration, inparticular during the early phase of the mealrelated insulin release. This results in a failure to clear the glucose loads from successive meals, contributing significantly to the diabetic fasting hyperglycemia. An attempt restore metabolic control by stimulating insulin secretion at meal times in the prandial state offers a new approach to the antihyperglycemic treatment of type 2 diabetes. In the new therapeutic concept, a rapid acting oral insulin secreting drug, administered before main meals, stimulating insulin release together with the meal itself, mimics the nondiabetic insulin response during the prandial state. Chronic stimulation of insulin secretion between meals as is typically the case during sulphonylurea therapy, is avoided. Tailoring treatment to meal times with shortacting insulin secreting drug, before each principal meal may improve the flexibility of meal times to individual lifestyle need. The first drug of the new prandial regulator generation is repaglinide. Its antihyperglycemic efficacy has been demonstrated in placebo-controlled studies, diminishing the glycated haemoglobin HbA 1c by 1. 7 to 2.1%. Compared to sulphonylurea drugs, it was equally or rnore efficient, and safe due to less frequent and milder hypoglicemic episodes occuring only by day-time. 90 % of repaglinide is cleared via liver. Conclusions. The principle of prandial glucose regulation repesents a new approach to the type 2 diabetes treatment. The first prandial regulator is repaglinide, characterised by good clinicall efficacy, and, first of all, safety. The dosing together with principal means short time of action, and its minimal clearence via kidneys all lead to much reduced risk of hypoglicemic epiosodes compared to salphonylurea treatment.
Summary		Izhodišča. Celica beta pri človeku s sladkorno boleznijo tipa 2 se ni sposobna normalno odzivati na zvečano glikemijo, posebno v zgodnji fazi izločanja, ki jo izzove obrok mešane hrane. Posledica je neučinkovito vraanje glukoze v krvi po obroku na raven pred njim, kar bistveno pripomore tudi k hiperglikemiji na tešče. Poskus obnove sposobnosti uravnavanja glikemije s spodbujanjem izločanja inzulina v prandialnem obdobju (času, ko se absorbirajo hranila iz prebavil) predstavlja novo možnost zdravljenja sladkorne bolezni tipa 2. Pri prandialni regulaciji glikemije posnemamo fiziološko izločanje inzulina s kratko delujočim peroralnim sekretagogom inzulina, odmerjenim pred glavnim obrokom hrane. Izognemo se neustrezno visoki koncentraciji inzulina med obroki, kar je sicer tipično za zdravljenje s pripravki sulfonilsečnine, s čimer zmanjšamo tveganje za hipoglikemijo v primerjavi z njo.. Odmerjanje pred vsakim glavnim obrokom bolniku omogoči, da si prilagajata število glavnih obrokov dnevno svojemu življenjskemu slogu. Prvi iz generacije prandialnih regulatorjev je repaglinid. Učinkovitost njegovega delovanja je sorazmerno velika, saj v primerjavi s placebom zmanjša raven glikiranega hemoglobina HbA1c za 1,7 do 2,1 %. V primerjavi s pripravki sulfonilsečnine je enako ali bolj učinkovit, predvsem pa je bolj varen na račun redkejših, manj hudih in samo podnevi pojavljajočih se hipoglikemij. 90 n% se ga izloči z žolčem.
Descriptors		DIABETES MELLITUS, NON-INSULIN-DEPENDENT INSULIN BLOOD GLUCOSE HYPOGLYCEMIA SULFONYLUREA COMPOUNDS HYPOGLYCEMIC AGENTS