Metformina, el rey está desnudo en diabetes también?

Foro general ciencia, medicina, nutrición, salud pública, política

Moderador: Fisio

Metformina, el rey está desnudo en diabetes también?

Notapor Fisio » Lun, 28 Jul 2014, 03:57

Metformina, el rey está desnudo en diabetes también?

El fármaco de elección en diabetes actual sin mucha evidencia en cuanto a mortalidad cardiovascular y total. Todo este mito de la "cura química" está haciendo mucho daño a la salud de la gente, porque dejan su salud en manos de un fármaco bajo la creencia inducida por la publicidad biosanitaria de su poder terapéutico, y entonces no hace otras cosas que sí son terapéuticas. Es decir, los fármacos, y la medicina actual, desplazan otras terapias que sí son efectivas como ejercicio y nutrición, y fomentan hábitos poco saludables y consumo de fármacos en su mayoría sin evidencia de eficacia excepto surrogates, aún menos de efectividad.

Metformin may not reduce cardiovascular risk or all-cause mortality

The treatment of hyperglycaemia is considered as one of the tools for preventing cardiovascular disease in Type 1 and Type 2 diabetic (T2D) patients.1 ,2 Metformin is recommended as the first-line drug for T2D by most international guidelines (IDF.2005. http://www.idf.org, 2007. http://www.aace.com, http://www.diabetesjournals.org, http://www.nice.org.uk/CG66). The preference for metformin over other available drugs is based on its efficacy on blood glucose control, tolerability, safety and low cost (IDF.2005. http://www.idf.org, 2007. http://www.aace.com, http://www.diabetesjournals.org, http://www.nice.org.uk/CG66). Metformin seems to have a favourable profile of action on several extraglycaemic risk factors, including lipids, …


http://ebm.bmj.com/content/18/2/e13.extract


The UK Prospective Diabetes Study showed that metformin decreases mortality compared to diet alone in overweight patients with type 2 diabetes mellitus. Since then, it has been the first-line treatment in overweight patients with type 2 diabetes. However, metformin-sulphonylurea bitherapy may increase mortality.
Methods and Findings

This meta-analysis of randomised controlled trials evaluated metformin efficacy (in studies of metformin versus diet alone, versus placebo, and versus no treatment; metformin as an add-on therapy; and metformin withdrawal) against cardiovascular morbidity or mortality in patients with type 2 diabetes. We searched Medline, Embase, and the Cochrane database. Primary end points were all-cause mortality and cardiovascular death. Secondary end points included all myocardial infarctions, all strokes, congestive heart failure, peripheral vascular disease, leg amputations, and microvascular complications. Thirteen randomised controlled trials (13,110 patients) were retrieved; 9,560 patients were given metformin, and 3,550 patients were given conventional treatment or placebo. Metformin did not significantly affect the primary outcomes all-cause mortality, risk ratio (RR) = 0.99 (95% CI: 0.75 to 1.31), and cardiovascular mortality, RR = 1.05 (95% CI: 0.67 to 1.64). The secondary outcomes were also unaffected by metformin treatment: all myocardial infarctions, RR = 0.90 (95% CI: 0.74 to 1.09); all strokes, RR = 0.76 (95% CI: 0.51 to 1.14); heart failure, RR = 1.03 (95% CI: 0.67 to 1.59); peripheral vascular disease, RR = 0.90 (95% CI: 0.46 to 1.78); leg amputations, RR = 1.04 (95% CI: 0.44 to 2.44); and microvascular complications, RR = 0.83 (95% CI: 0.59 to 1.17). For all-cause mortality and cardiovascular mortality, there was significant heterogeneity when including the UK Prospective Diabetes Study subgroups (I2 = 41% and 59%). There was significant interaction with sulphonylurea as a concomitant treatment for myocardial infarction (p = 0.10 and 0.02, respectively).
Conclusions

Although metformin is considered the gold standard, its benefit/risk ratio remains uncertain. We cannot exclude a 25% reduction or a 31% increase in all-cause mortality. We cannot exclude a 33% reduction or a 64% increase in cardiovascular mortality. Further studies are needed to clarify this situation.


http://www.plosmedicine.org/article/inf ... ed.1001204
Avatar de Usuario
Fisio
Administrador del Sitio
 
Mensajes: 6246
Registrado: Dom, 01 Sep 2013, 14:18

Re: Metformina, el rey está desnudo en diabetes también?

Notapor Fisio » Lun, 28 Jul 2014, 19:41

Un meta anterior tampoco encontraba disminucion en eventos cardiovasculares, aunque deja una posibilidad sobre mortalidad vs no therapy

El anterior tiene como problema la inclusion de rct de corta duración.

Effect of metformin on cardiovascular events and mortality: a meta-analysis of randomized clinical trials.
Lamanna C1, Monami M, Marchionni N, Mannucci E.
Author information
Abstract
AIM:

Some studies suggested that metformin could reduce cardiovascular risk to a greater extent than that determined by glucose reduction. Aim of the present meta-analysis is to assess the effects of metformin on the incidence of cardiovascular events and mortality.
METHODS:

An extensive search of Medline, EMBASE and the Cochrane Library (any date up to 31 October 2009) was performed for all trials containing the word 'metformin'. Randomized trials with a duration ≥52 weeks were included. A meta-regression analysis was also performed to identify factors associated with cardiovascular morbidity and mortality in metformin-treated patients.
RESULTS:

A total of 35 clinical trials were selected including 7171 and 11 301 participants treated with metformin and comparator, respectively, who had 451 and 775 cardiovascular (CV) events, respectively. Overall, metformin was not associated with significant harm or benefit on cardiovascular events (MH-OR 0.94[0.82-1.07], p = 0.34). A significant benefit was observed in trials versus placebo/no therapy (MH-OR 0.79[0.64-0.98], p = 0.031), but not in active-comparator trials (MH-OR 1.03[0.72-1.77], p = 0.89). Meta-regression showed a significant correlation of the effect of metformin on cardiovascular events with trial duration and with minimum and maximum age for inclusion, meaning that the drug appeared to be more beneficial in longer trials enrolling younger patients. It is likely that metformin monotherapy is associated with improved survival (MH-OR: 0.801[0.625-1.024], p = 0.076). However, concomitant use with sulphonylureas was associated with reduced survival (MH-OR: 1.432[1.068-1.918], p = 0.016).
CONCLUSION:

Available evidence seems to exclude any overall harmful effect of metformin on cardiovascular risk, suggesting a possible benefit versus placebo/no treatment. The observed detrimental effect of the combination with sulphonylureas deserves further investigation.


http://www.ncbi.nlm.nih.gov/pubmed/21205121
Avatar de Usuario
Fisio
Administrador del Sitio
 
Mensajes: 6246
Registrado: Dom, 01 Sep 2013, 14:18


Volver a Muscleblog

¿Quién está conectado?

Usuarios navegando por este Foro: No hay usuarios registrados visitando el Foro y 3 invitados