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GLP-1 academy

Um portal repleto de conteúdos interativos e dinâmicos, com novidades sobre o tratamento do diabetes tipo 2 com GLP-1, sempre preparados pensando em sua constante atualização científica.

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*Exemplos de diretrizes médicas – lista não exaustiva; ACC – American College of Cardiology; ADA – American Diabetes Association; AHA – American Heart Association; CV – cardiovascular; DCV – doença cardiovascular; EASD – Associação Europeia para o Estudo do Diabetes; ESC – Sociedade Europeia de Cardiologia. DCVAS – Doença cardiovascular aterosclerótica, DRC – doença renal crônica; IC – insuficiência cardíaca

Referências: 1. Pesquisa “Quando o diabetes toca o coração”. Área de inteligência de mercado da Editora Abril, 2019. Disponível em: <https://www.quemvediabetesvecoracao.com.br/>

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1. Low Wang CC, Hess CN, Hiatt WR, et al. Clinical update: Cardiovascular disease in diabetes mellitus: Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus - mechanisms, management, and clinical considerations. Circulation. 2016;133:2459–2502.
2. International Diabetes Federation. Taking Diabetes to Heart Survey – Global survey on CVD awareness and knowledge among people with type 2 diabetes. Brussels, Belgium: International Diabetes Federation, 2018. www.idf.org/takingdiabetes2heart
3. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002;287:2570–2581.
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5. Napoli C, Triggiani M, Palumbo G, et al. Glycosylation enhances oxygen radical-induced modifications and decreases acetylhydrolase activity of human low density lipoprotein. Basic Res Cardiol. 1997;92:96–105.
6. Einarson TR, Acs A, Ludwig C, et al. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018;17:83.
7. IQVIA Disease Analyzer for FR (Apr18 data), Germany (Apr18 data) and UK (Dec17 Data); LRx&Dx for USA (Apr18 data)
8. McGurnaghan S, Blackbourn LAK, Mocevic E, et al. Cardiovascular disease prevalence and risk factor prevalence in Type 2 diabetes: a contemporary analysis. Diabet Med. 2019;36:718-725.
9. Barquera S, Pedroza-Tobias A, Medina C, et al. Global overview of the epidemiology of atherosclerotic cardiovascular disease. Arch Med Res. 2015;46:328–338.
10. Newman JD, Schwartzbard AZ, Weintraub HS, et al. Primary prevention of cardiovascular disease in diabetes mellitus. J Am Coll Cardiol. 2017;70:883–893
11. Almdal T, Scharling H, Jensen JS, et al. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med. 2004;164:1422-1426.
12. Fox C, Coady S, Sorlie P, et al. Trends in cardiovascular complications of diabetes. JAMA. 2004;292:2495-2499.
13. Robinson RG, Jorge RE. Post-stroke depression: a review. Am J Psychiatry. 2016;173:221–231.
14. Feng HP, Chien WC, Cheng WT, et al. Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study. Medicine (Baltimore). 2016;95:e4464.
15. Emerging Risk Factors Collaboration, Di Angelantonio E, Kaptoge S, et al. Association of cardiometabolic multimorbidity with mortality. JAMA. 2015;314:52–60.
16. Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–322.
17. Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–1844.
18. Neal B, Perkovic V and Matthews DR. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017; 377:2099.
19. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015; 373:2117–2128.
20. Verma S, Leiter LA, Mazer CD, et al. Liraglutide reduces cardiovascular events and mortality in type 2 diabetes mellitus independently of baseline low-density lipoprotein cholesterol levels and statin use. Circulation. 2018;138:1605–1607.
21. Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61:2461-2498.
22. Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2019;63:221-228.
23. Das SR, Everett BM, Birtcher KK, et al. 2018 ACC expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes and atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2018;72:3200-3223.
24. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;140:e596-e646.
25. Cosentino F, Grant P, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD). Eur Heart J. 2020;41:255-323.

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1. Højberg PV, Vilsbøll T, Rabøl R, et al. Four weeks of near-normalisation of blood glucose improves the insulin response to glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide in patients with type 2 diabetes. Diabetologia. 2009;52:199-207.
2. Kjems LL, Holst JJ, Vølund A, Madsbad S. The influence of GLP-1 on glucose-stimulated insulin secretion: effects on beta-cell sensitivity in type 2 and nondiabetic subjects. Diabetes. 2003;52:380-386.
3. Calanna S, Christensen M, Holst JJ, et al. Secretion of glucagon-like peptide-1 in patients with type 2 diabetes mellitus: systematic review and meta-analyses of clinical studies. Diabetologia. 2013;56:965-972.
4. Aronoff SL, Berkowitz K, Shreiner B, Want L. Glucose metabolism and regulation: beyond insulin and glucagon. Diabetes Spectrum. 2004;17:183-190.
5. Campbell JE, Drucker DJ. Pharmacology, physiology, and mechanisms of incretin hormone action. Cell Metab. 2013;17:819-837.
6. Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab. 2018;27:740-756.
7. Korner M, Stöckli M, Waser B, Reubi JC. GLP-1 receptor expression in human tumors and human normal tissues: potential for in vivo targeting. J Nucl Med. 2007;48:736-743.
8. Muscogiuri G, DeFronzo RA, Gastaldelli A, Holst JJ. Glucagon-like peptide-1 and the central/peripheral nervous system: crosstalk in diabetes. Trends Endocrinol Metab. 2017;28:88-103.
9. Nauck MA, Meier JJ. Incretin hormones: their role in health and disease. Diabetes Obes Metab. 2018;20:5-21.
10. DeFronzo RA. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58:773-795.
11. Holst JJ, Knop FK, Vilsbøll T, Krarup T, Madsbad S. Loss of incretin effect is a specific, important, and early characteristic of type 2 diabetes. Diabetes Care. 2011;34(suppl 2):S251-S257.
12. Leahy JL. Pathogenesis of type 2 diabetes. Arch Med Res. 2005;36:197-209.
13. Herzberg-Schäfer S, Heni M, Stefan N, Häring H-U, Fritsche A. Impairment of GLP1-induced insulin secretion: role of genetic background, insulin resistance and hyperglycaemia. Diabetes Obes Metab. 2012;14(suppl 3):85-90.
14. Nauck MA, Meier JJ. GIP and GLP-1: stepsiblings rather than monozygotic twins within the incretin family. Diabetes. 2019;68:897-900.
15. Simonson G, Cuddihy R, Reader D, Bergenstal R. International diabetes center treatment of type 2 diabetes glucose algorithm. Diabetes Manage. 2011:1:175-189.

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* Baseado em estimativas da Organização Mundial da Saúde. 11

5. Low Wang CC, Hess CN, Hiatt WR, et al. Clinical Update Cardiovascular Disease in Diabetes Mellitus: Atherosclerotic Cardiovascular Disease and Heart Failure in Type 2 Diabetes Mellitus - Mechanisms, Management, and Clinical Considerations. Circulation. 2016;133:2459–2502.
6. Taking Diabetes to Heart. A global patient survey conducted in collaboration between Novo Nordisk and the International Diabetes Federation (2018).
10. Organização Mundial da Saúde. Obesity and overweight fact sheet. Disponível em: . Acesso em: 8 de maio de 2017.
11. Klein S, Romijn JA. Obesity. Kronenberg HM, ed. Williams Textbook of Endocrinology. 11th ed. Philadelphia, PA: Elsevier/Saunders;2011:1633-1659.Hlatky MA (atual ref 13).
12. Hlatky MA, Chung SC, Escobedo J, et al. BARI 2D Study Group. The effect of obesity on quality of life in patients with diabetes and coronary artery disease. Am Heart J. 2010;159(2):292-300.
13. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus-mechanisms, management, and clinicai considerations. Circulation. 2016;133(24):2459-2502.
14. Martín-Timón I, Sevillano-Collantes C, Segura-Galindo A, Del Cañizo-Gómez FJ.Type 2 diabetes and cardiovascular disease: have all risk factors the same strength? World J Diabetes. 2014;5(4):444-470.

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AR GLP-1 – agonista do receptor GLP-1. *A dose inicial de 0,25 mg não é uma dose de manutenção e se destina a ajudar os pacientes a se adaptarem ao tratamento. Imagens meramente ilustrativas.

Referências: 1. Bula do produto Ozempic. Aprovada pela ANVISA em 26/06/2020. 2. Sorli C, et al. Efficacy and safety of once-weekly semaglutide monotherapy versus placebo in patients with type 2 diabetes (SUSTAIN 1): a double-blind, randomised, placebo-controlled, parallel-group, multinational, multicentre phase 3a trial Lancet Diabetes Endocrinol 2017;5:251-260. 3. Ahrén B, et al. Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial Lancet Diabetes Endocrinol 2017;5:341-354. 4. Ahmann AJ, et al. Efficacy and Safety of Once-Weekly Semaglutide Versus Exenatide ER in Subjects With Type 2 Diabetes (SUSTAIN 3): A 56-Week, Open-Label, Randomized Clinical Trial. Diabetes Care 2017; DOI:10.2337/dc17-0417. 5. Aroda V, et al. Efficacy and safety of once-weekly semaglutide versus once-daily insulin glargine as add-on to metformin (with or without sulfonylureas) in insulin-naive patients with type 2 diabetes (SUSTAIN 4): a randomised, open-label, parallel-group, multicentre, multinational, phase 3a trial. Lancet Diabetes Endocrinol 2017;5:355-366. 6. Rodbard H, et al. Semaglutide Added to Basal Insulin in Type 2 Diabetes (SUSTAIN 5): A Randomized, Controlled Trial. J Clin Endocrinol Metab, June 2018,103(6):2291-2301. 7. Pratley RE, et al. SUSTAIN 7. Lancet Diabetes Endocrinol 2018. 8. Marso SP, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes (SUSTAIN 6). N Engl J Med 2016;375:1834-1844.

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Referências: 1. Garber A. et al - Liraglutide versus glimepiride monotherapy for type 2 diabetes (LEAD-3 Mono): a randomised, 52-week, phase III, double-blind, parallel-treatment trial. Lancet 2009; 373 (9662): 473-81. 2. Marre M. et al – Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with type 2 diabetes (LEAD-1 SU). Diabetic Medicine 2009; 26:268-278. 3. Nauck M. et al – Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes: the LEAD (liraglutide effect and action in diabetes)-2 study. Diabetes Care 2009; 32 (1): 84-90.4. Zinman B. et al – Efficay and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolinedione in patients with type 2 diabetes (LEAD-4 Met+TZD). Diabetes Care 2009; 32(7): 1224-1230. 5. Russell-Jones D.et al – Liraglutide vs insulin glargine and placebo in combination with metformin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5 met+SU): a randomised controlled trial. Diabetologia 2009; 52:2046-2055. 6. Mathieu C. et al - A comparison of adding liraglutide versus a single daily dose of insulin aspart to insulin degludec in subjects with type 2 diabetes (BEGIN: VICTOZA ADD-ON). Diabetes,Obesity and Metabolism 2014. 16(7): 636–644. 7. Devries JH et al - Sequential Intensification of Metformin Treatment in Type 2 Diabetes With Liraglutide Followed by Randomized Addition of Basal Insulin Prompted by A1C Targets. Diabetes Care 2012. 35:1446-1454. 8. Nauck M. et al - Once-Daily Liraglutide Versus Lixisenatide as Add-on to Metformin in Type 2 Diabetes: A 26-Week Randomized Controlled Clinical Trial. Diabetes Care. 2016 Sep;39(9):1501- 9. doi: 10.2337/dc15-2479. Epub 2016 Jun 16. 9. Marso SP et al - Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311-22.10. Tamborlane WV et al. Liraglutide in Children and Adolescents with Type 2 Diabetes. N Engl J Med. 2019; 381:637-646. 11. Blonde L, Belousova L, Fainberg U, Garcia-Hernandez PA, Jain SM, Kaltoft MS, Mosenzon O, Nafach J, Palle MS, Rea R. Liraglutide as add-on to SGLT2 inhibitors in patients with inadequately controlled type 2 diabetes: LIRA-ADD2SGLT2i, a 26-week, randomized, double-blind, placebocontrolled trial. Diabetes Obes Metab. 2020 Jan 27. 12. Dados IMS de comercialização do produto. 13. Bula do produto Victoza®. 14. Marre M, Shaw J, Brändle M, Bebakar WM, Bebakar WM, Kamaruddin NA, Strand J, et al. Liraglutide, a once-daily human GLP-1 analogue, added to a sulphonylurea over 26 weeks produces greater improvements in glycaemic and weight control compared with adding rosiglitazone or placebo in subjects with Type 2 diabetes (LEAD-1 SU). Diabet Med. 2009 Mar;26(3):268-78. 15. Nauck M, Frid A, Hermansen K, Shah NS, Tankova T, Mitha IH, et al; LEAD-2 Study Group. Efficacy and safety comparison of liraglutide, glimepiride, and placebo, all in combination with metformin, in type 2 diabetes. Diabetes Care. 2009 Jan;32(1):84-90. 16. Zinman B, Gerich J, Buse JB, Lewin A, Schwartz S, Raskin P, et al; LEAD-4 Study Investigators. Efficacy and safety of the human glucagon-like peptide-1 analog liraglutide in combination with metformin and thiazolidinedione in patients with type 2 diabetes (LEAD-4 Met+TZD). Diabetes Care. 2009 Jul;32(7):1224-30. 17. Russell-Jones D, Vaag A, Schmitz O, Sethi BK, Lalic N, Antic S, et al; Liraglutide Effect and Action in Diabetes 5 (LEAD-5) met+SU Study Group. Liraglutine vs insulin glargine and placebo combination with metformin and sulfonylurea therapy in type 2 diabetes mellitus (LEAD-5 met+SU): a randomised controlled trial. Diabetologia. 2009 Oct;52(10):2046-55. 18. Buse JB, Rosenstock J, Sesti G, Schmidt WE, Montanya E, Brett JH, et al; LEAD-6 Study Group. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group,multinational, open-label trial (LEAD-6). Lancet. 2009 Jul;374(9683):39-47. 19. Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018.doi:10.2337/dci18-0033.

*comprovadas por 11 estudos clínicos.

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Referências: 1. Bula de Saxenda aprovada pela ANVISA em 03/08/2020.

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