Shin Empagliflozin da nasara da masu ciwon sukari tare da cutar koda suna jiran
Idan yazo da maganin cututtukan cututtukan ciwon sukari da kuma rage hadarin ƙwayar koda (buƙatar dialysis ko koda kaya ), ba kowane rana da muke ji ba game da magunguna waɗanda ke tabbatar da maganganu irin su, "Holy Grail,", "game changer", "manyan nasara " , da dai sauransu. Da kyau, zamu iya kasancewa a cikin waɗannan lokuta masu mahimmanci a magani inda likita ya nuna alamun da ya dace don tabbatar da waɗannan alamu.
Akwai magani don kula da ciwon sukari, wani abu da ake kira empagliflozin (wanda aka sani da sunan mai suna Jardiance). Duk da haka, don fahimtar tasirin empagliflozin a cikin hana hana rashin ƙarfi na koda, yana da muhimmanci a san wani abu na baya.
Dalilin da yasa Ciwon sukari Yaya Kashe Kodan
Ciwon sukari yana da hannayen ƙasa da ƙananan dalilin dalili na koda koda da kuma gazawar koda a cikin mafi yawan kasashen da suka ci gaba. Hakan ya ci gaba da tasowa yayin da tasirinsa ya ci gaba da haifar da mafarki mai ban tsoro na jama'a. Wannan cuta ne mai taushi, da wuya sau da yawa ya watsi har sai mai haƙuri zai fara tasowa.
Kodan ba kwayoyin halitta kawai ba ne kawai suka shafe ta wannan cuta. Tun da ciwon sukari ya lalata jini, a cikin al'ada, duk wani abu ne mai kyau game. Dangane da girman jinin da ake ciki, cutar sutura ta jini ta haifar da ciwon sukari ya zama rabuwa ga al'ada (misali.
cututtukan cututtuka a cikin idanu, cututtukan koda ko ciwon sukari masu ciwon sukari, da dai sauransu), da kuma rikice-rikice na macrovascular (misali cututtukan zuciya na zuciya da cututtukan zuciya da ke haifar da haɗarin haɗarin zuciya, cututtukan zuciya na cerebrovascular a cikin kwakwalwa na jini da ke kara haɗarin annoba, da sauransu).
Bisa ga abin da ke sama, yana da ganewa cewa duk lokacin da aka samu nasara a bangaren kula da ciwon sukari, duniya tana ba da hankali.
Magunguna da marasa lafiya jiran labarai tare da bated numfashi. Shin sababbin maganin miyagun ƙwayoyi ne zai rage haɗarin cutar mutuwa ta mutuwa? Yaya game da hare-haren zuciya ko bugun jini? Wata kila rage haɗarin ciwon sukari koda maye?
Ko kuma, kamar yadda sau da yawa yake , zai zama abin takaici ne a yayin da inganta tsarin kula da ciwon sukari ba ya fassara zuwa mafi mahimmancin sakamakon gwaji ga marasa lafiya? A gaskiya ma, akwai binciken da ke bayar da rahotanni game da hadarin mutuwa da cutar da wasu magunguna masu ciwon sukari. Saboda saboda wannan batu na cewa FDA yanzu yana buƙatar dukan sababbin magungunan ƙwayoyi masu ciwon sukari ta hanyar maganin masu ciwon sukari don tabbatar da cewa sababbin magungunan su ba za su kara haɗarin cutar da ciwo ba.
Zai yiwu Sabbin Magungunan Inganta Ciwon sukari da Kwayar Kwayar cuta?
Shekaru goma da suka gabata sun ga wasu magungunan sababbin magungunan da aka yarda da su don kula da ciwon sukari. Bayanan misalai sune:
- GLP-1 Agonists ƙara yawan insulin release by pancreas
- DPP-4 Masu hanawa sun shafe aikin GLP-1 saboda haka kai tsaye kai tsaye sunyi aiki guda kamar yadda aka sama
- SGLT-2 Masu hanawa sun hana glucose (sugar) reabsorption a koda. Wadannan kwayoyi sune mayar da hankali ga maganganu a wannan labarin
Ta yaya Dd SGLT-2 masu hanawa ke shafar koda?
SGLT tana tsaye ne ga masu dauke da sodium-glucose.
Don sanya shi a cikin sauƙi, yana da nauyin gina jiki wanda ke tattare da daukar nauyin abubuwa biyu a cikin koda, daga fitsari cikin jini. Daya daga cikin wadannan shine sodium, ɗayan kuma glucose wanda shine "piggybacks" a kan zirga-zirga na sodium. Lambar "2" tana nufin ainihin irin furotin da aka gano a cikin tsarin kullun kodaya, wani ɓangaren da ake kira "tubular kusa". Akwai kuma SGLT-1 amma wannan ke da alhakin ƙananan ƙananan wannan sufuri).
Bayanin kwayoyin kwayoyin halitta yana da amfani don fahimtar dalilin da yasa endocrinology da nephrology duniya ke faruwa gaga wadannan sababbin kwayoyi, SGLT-2 inhibitors.
Yanzu mun san abin da SGLT-2 ke takawa, yana iya zama sauƙin fahimtar abin da zai faru idan ka kasance "toshe" aikin wannan furotin . Koda ba zai iya karbar glucose wanda aka riga ya tsaftace a cikin fitsari (wanda shine abinda yake sabawa), kuma yafi dacewa cewa sukari / glucose ya shiga cikin bayan gida . Wanne yana nufin ƙananan glucose da aka riƙe a cikin jininka, kuma watakila mafi yawan ciwon sukari ne.
Magungunan da aka tattauna a cikin wannan labarin shine wani abu da ake kira empagliflozin (Jardiance), mai hana SGLT-2 wanda FDA ta amince don maganin ciwon sukari iri na 2. Yayinda wasu daga cikin sababbin magungunan ƙwayar ciwon sukari sun haɗa su tare da sayen slick suna nuna amfani da su, yawancin gwaji sun kasa nuna rashin haɗari ga magungunan asibiti (kamar cike da ciwon zuciya ko haɗari) tare da waɗannan magunguna, idan aka kwatanta da maganin gargajiya domin kula da ciwon sukari. Don sauyawa, yayin da sabon magani ya nuna alamar ƙarfafa rage cututtukan zuciya, shanyewar jiki, ko rashin cin nasara koda, dole ne ya kasance cibiyar kulawa.
Traditional Treatment na Ciwon sukari Koda Cututtuka
Abin takaici, a cikin shekaru 20 da suka gabata, ba mu yi wata matsala mai kyau wajen inganta lafiyar marasa lafiya da cutar ciwon sukari ba. Hanyar kulawa na yau da kullum yana dogara ne akan maganganun jigilar jini kamar maganin jini, ko rage rage asarar furotin a cikin fitsari (amfani da magunguna da ake kira ACE-inhibitors ko masu binciken masu karba na angiotensin). Zamu iya yin amfani da wadannan maganganu tare da wasu manufofi, kamar kara girman alkali a cikin jini, mai kyau mai kula da ciwon sukari, da kuma rage matakan acid. Duk da haka, a lokuta da yawa waɗannan ƙaddamarwa bazai isa ba don yin tasiri mai mahimmanci ga yiwuwar mai ci gaba da ƙwarewar koda.
Za a iya Amfani da Mu'ujizai don Gurasar Ciwon Nasara?
Akwai wasu dalilai da za su gaskata cewa empagliflozin na iya karya "rashin lafiya" na shekaru ashirin da suka gabata. Amfanin Empagliflozin ya fara tasirin ciwon sukari a cikin shekara ta 2015 lokacin da sakamakon binciken da ake kira EMPA-REG ya nuna cewa yana da tasirin gaske akan rage cututtukan zuciya, cututtukan zuciya ba tare da bugun jini ba. Sakamakon haka an sake bugawa a cikin New England Journal of Medicine.
Wannan binciken shi ne babban gwajin da ya shafi mutane 7000 wadanda ke fama da ciwon sukari a kasashe 42 a cibiyoyin da yawa. Yana da muhimmanci a lura cewa fiye da kashi 80 na mahalarta sun rigaya a kan maganin lafiya na cututtukan ciwon sukari (tare da sama da kashi 80 cikin dari akan masu hana masu kariya na ACE ko masu binciken masu karba na angiotensin). Kusan dukkan marasa lafiya sun kamu da cututtuka na cututtukan zuciya. Girman gwajin shine daya daga cikin abubuwan da suka kara da cewa sunyi iyakancewa.
Idan aka ba da wannan sakamako mai ban sha'awa, karin bincike game da tasirin empagliflozin akan ci gaba da cigaba da cutar koda. Wannan ya haifar da wani labarin na biyu wanda aka buga a watan Yuni 2016, wanda ya mayar da hankali ga abin da miyagun ƙwayoyi ke yi ga kodan. Musamman, binciken ya dubi nauyin ciwo na aikin koda (a cikin marasa lafiya ba tare da miyagun ƙwayoyi ba). Anyi wannan ta hanyar aunawa da tasowa akan launi na creatinine ko asarar hasara a cikin fitsari. Sakamakon karshe ya nuna cewa cutar cututtukan cututtuka na masu ciwon sukari wanda ke da haɗari ga cututtuka na zuciya da jijiyoyin jini, kuma waɗanda suke ɗaukar empagliflozin (kara da cewa "kulawa nagari") zai iya ganin wani abu mai hankali a hankali a cikin aikin koda waɗanda ba su da. Magunguna wadanda ke dauke da wannan kwayar cutar sun fi dacewa da karfin jini, tare da rage karfin jini, ƙuƙwalwar ƙafa, nauyi, da matakan acid.
Hanyoyin Cutar da Tambayoyin da ba a amsa ba
Duk lokacin da ake kira miyagun ƙwayoyi "mai canzawa na wasan", yana da kyau kyakkyawan tunani don komawa baya kuma duba tare da ƙwayar lafiya na skepticism kimiyya. Tambayoyi game da ingancinta, watakila? Ga wasu tambayoyin da har yanzu suna buƙata a dogara da su a wannan lokaci:
- Akwai wani abu na musamman game da empagliflozin? Shin zamu ga irin wannan amfanin daga sauran kwayoyi wanda ke cikin magunguna guda daya (SGLT-2 masu hanawa, misali canagliflozin, dapagliflozin)?
- Shin amfanin da ake zaton yana da sakamako ne na rashin karfin jini ko nauyi, wanda aka gani a marasa lafiya wanda ya ɗauki empagliflozin?
- Shin mafi kyawun jinin jini yana iya bayyana fifiko na empagliflozin?
Batutuwan da ke sama suna tayar da wani batu na alkawalin da aka yi wa sama da tsalle. Mene ne idan za mu iya harba mafi kyau na jini / cutar karfin jini ta amfani da magungunan da ake ciki da kuma salon salon (tunanin wani abu kamar metformin + lisinopril + cin abinci / motsa jiki) ? Shin, wannan zai ba mu wannan bango don buƙata, watakila a wani ƙananan kudin? Wa] annan tambayoyin da za su kasance batutuwa na bincike na shekaru masu zuwa.
A ƙarshe, ka tuna da lalacewar tasirin empagliflozin da aka ruwaito a cikin fitina, wasu daga cikinsu:
- Hanyoyin cuta na al'ada
- Urosepsis
- Duk da yake shari'ar empagliflozin ba ta bayar da rahoton wannan ba, FDA ta bayar da gargadi game da hadarin ƙwayar koda ta hanyar amfani da "'yan uwanta" (canagliflozin, dapagliflozin)
Maganar Take-Home ga Mai haƙuri
- Sakamakon wadannan gwaje-gwaje guda biyu, (a kan sakamakon rikice-rikice na zuciya, cututtuka, da kuma koda) wanda aka buga a cikin 'yan watanni ba shakka ba mai ban sha'awa ba ne amma zai iya buƙatar tabbatarwa a nan gaba.
- Nazarin ya nuna cewa empagliflozin na iya rage hadarin zuciya, shanyewar jiki, da mutuwa yayin da aka kara wa daidaitattun masu ciwon sukari a marasa lafiya da masu ciwon sukari iri na 2 wadanda ke da haɗari ga cutar cututtukan zuciya.
- Empagliflozin yana iya jinkirta sau da yawa a cikin aikin koda wanda aka gani a cikin haɗarin masu ciwon sukari. Har yanzu ba mu san ko wane ne saboda sakamako mai kariya a kan koda akan glycemic (jini sugar).
- Idan an tabbatar da sakamakon a wasu gwaji, a karo na farko watakila, zamu iya motsawa a tsakanin hanyoyin da ake amfani dasu don magance cututtukan ciwon sukari (kamar jini da sukari). Wannan zai iya ba wa marasa lafiya wani abu da zai iya haɓaka ainihin damar samun su a kan dialysis.
Da fatan, wadannan sababbin abubuwan da suka faru / nasara ba kawai ba ne kawai "sa'ar farawa", kamar yadda ya faru da wasu magunguna don cutar cututtuka na ciwon sukari a baya (Bardoxolone shi ne batun a cikin batu). Tun lokacin da aka buga wadannan gwaje-gwajen biyu, na ga wani mummunan adadi na batutuwa marasa daidaituwa a cikin layi na kan hanyar hyperbole. Wani bayani daga edita wanda aka wallafa a cikin New England Journal of Medicine (littafin da aka buga a baya inda aka buga littattafan farko) ya jawo ainihin abin da muka sani har yanzu:
... "an bar mu tare da bambance-bambance da ke nuna ƙarfafawa, duk da haka ba '' gudu gida 'ba game da gudanar da ciwon sukari. A cikin shekaru masu zuwa, sarrafawa da gwagwarmaya masu dacewa da suka hada da sababbin wakilai tare da tsofaffin jamiái na iya taimaka wa sake fassara wani tsari na magunguna mafi mahimmanci ga miliyoyin mutanen da ciwon sukari ya kamu da rayukansu.
> Sources:
> Empagliflozin da ci gaba na koda cuta a cikin irin 2 ciwon sukari .Wane C, et al; EMPA-REG OUTCOME Masu bincike. N Engl J Med. 2016 Jun 14
> Empagliflozin, Hanyoyin Tsarin Lafiya, da Mutuwa a Cikin Tsari na 2 na Ciwon sukari. Zinman B, et al; EMPA-REG OUTCOME Investigators.N Engl J Med.2015 Nov 26