title: [Adjunctive therapies to glycaemic control of type 1 diabetes mellitus].
abstract: Since Diabetes Control and Complications Trial (DCCT), intensive therapy has been directed at achieving glucose and glycosylated hemoglobin (HbA1c) values as close to normal as possible regarding safety issues. However, hyperglycemia (especially postprandial hyperglycemia) and hypoglicemia continue to be problematic in the management of type 1 diabetes. The objective of associating other drugs to insulin therapy is to achieve better metabolic control lowering postprandial blood glucose levels. Adjunctive therapies can be divided in four categories based on their mechanism of action: enhancement of insulin action (e.g. the biguanides and thiazolidinediones), alteration of gastrointestinal nutrient delivery (e.g. acarbose and amylin) and other targets of action (e.g. pirenzepine, insulin-like growth factor I and glucagon-like peptide-1). Many of these agents have been found to be effective in short-term studies with decreases in HbA1c of 0.5-1%, lowering postprandial blood glucose levels and decreasing daily insulin doses.
authors.affiliation: Departamento de Medicina, Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil. gabbay@ajato.com.br
authors.forename: Mônica de A Lima
authors.initials: Mde A
authors.lastname: Gabbay
mesh_terms: D020909:Acarbose / Q000378:metabolism / Q000627:therapeutic use; D000682:Amyloid / Q000378:metabolism / Q000627:therapeutic use; D001786:Blood Glucose / Q000187:drug effects*; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy* / Q000378:metabolism; D004359:Drug Therapy, Combination; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000378:metabolism; D052216:Glucagon-Like Peptide 1 / Q000031:analogs & derivatives / Q000378:metabolism / Q000627:therapeutic use; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000378:metabolism; D007003:Hypoglycemia / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D054795:Incretins / Q000378:metabolism / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use*; D007334:Insulin-Like Growth Factor I / Q000378:metabolism / Q000627:therapeutic use; D058228:Islet Amyloid Polypeptide; D008687:Metformin / Q000627:therapeutic use; D018727:Muscarinic Antagonists / Q000378:metabolism / Q000627:therapeutic use; D010890:Pirenzepine / Q000378:metabolism / Q000627:therapeutic use; D019518:Postprandial Period; D045162:Thiazolidinediones / Q000627:therapeutic use*
chemical_list: D020909:Acarbose; D000682:Amyloid; D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D054795:Incretins; D007328:Insulin; D007334:Insulin-Like Growth Factor I; D058228:Islet Amyloid Polypeptide; D008687:Metformin; D018727:Muscarinic Antagonists; D010890:Pirenzepine; D045162:Thiazolidinediones; C105254:pramlintide