Annals of Oncology Advance Access published November 14, 2012 Maintaining success, reducing treatment burden,focusing on survivorship: highlights from the thirdEuropean consensus conference on diagnosis andtreatment of germ-cell cancerJ. Beyer1, P. Albers2, R. Altena3, J. Aparicio4, C. Bokemeyer5, J. Busch6, R. Cathomas7,E. Cavallin-Stahl8, N. W. Clarke9, J. Claßen10, G. Cohn-Cedermark11, A.
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Oral Diabetes Medications
Healthy eating and physical activity are the basic management tools for diabetes. Additionally, many people with type 2 diabetes require oral diabetes medications, insulin, or other medications to control their blood glucose levels if their eating habits and exercise are not managing their diabetes.1 How Do These Medications Work?
How Can Diabetes Medications Help Me?
Diabetes medications can make your pancreas release more insulin, In general, diabetic medications will help control high blood sugar in help your liver to make less sugar, make your muscles take in more people with diabetes. However, these medications work best when sugar, or slow the breakdown of starches into sugar.
used with meal planning and exercise. Although most people find that their blood sugar levels decrease when they begin taking their What Types of Oral Medications are Available to Treat
medication, the blood sugar still may not reach the normal range.3 Type 2 Diabetes?
What are the Chances that Diabetes Medications Will
There are six classes of diabetes pills and several combination oral Work for Me?3
medications. Each has a different way of helping you control your Your chances are good if you developed diabetes recently or have needed little or no insulin to keep your blood sugar near normal. Drugs that cause the body to release more insulin:
• Sulfonylureas include glipizide, glyburide and glimepiride among • Diet and exercise are key to managing your diabetes • Diabetes medications sometimes stop working after a • Meglitinides (e.g., Prandin®) act like “short-acting” sulfonylureas Drugs that sensitize the body to insulin:
• Switching to another oral diabetes medication does not work as well as adding to your current treatment of diabetic medication • Biguanides lower blood sugar by helping insulin work better— • Even if diabetes medications bring your blood sugar near the normal range, you may still need to take insulin if you have a • Thiazolidinediones (e.g., Actos®) help insulin work better in the • If you plan to become pregnant, it is recommended that you Drugs that slow or block the breakdown of starches:
• Alpha-Glucosidase inhibitors (e.g., Precose®) help the body to • There is no “best” drug or treatment for type 2 diabetes. lower blood sugar by blocking the breakdown of bread, potatoes, You may need to try more than one type of diabetes medication or a combination of diabetes medications.
Drugs that block the breakdown of a special enzyme, DPP-4:
• Januvia® helps to improve the levels of insulin produced by your For additional information on oral medications for type 2 diabetes, Copyright 2009 Prescription Solutions. Used with permission. PS0413 5/09.
Table 1. Oral Agents for Type 2 Diabetes 2-4
Class, Generic Name(Brand Name)
Alpha-Glucosidase Inhibitors (AGIs):
Advantages: Acarbose and miglitol normally do not cause weight gain.
Common side effects: Gas, bloating and diarrhea. Cautions: Because these medications work directly in the intestines, people with infl ammatory
bowel disease, other intestinal diseases, or obstructions should not take them.
Hypoglycemia: Acarbose and miglitol don’t cause low blood glucose (hypoglycemia) when used
alone. When used with certain other diabetes medications, low blood glucose can occur. In these
cases, treat hypoglycemia with pure glucose, such as glucose tablets or glucose gels, or fruit juice.
Metformin is usually taken with a meal.
Advantages: Metformin does not cause weight gain and may improve cholesterol levels. It does not
metformin, long-acting (Glucophage® XR, cause low blood glucose (hypoglycemia) when used alone. Common side effects: Nausea, diarrhea, or loss of appetite, but these should subside within a few
weeks. To minimize these side effects, take with meals. Lactic acidosis is a very rare, but serious side effect. Metformin may not be right for you if you have kidney problems or severe respiratory problems, are 80 or older, are taking medication for heart failure, have a history of liver disease, drink alcohol excessively, or are hospitalized.
Advantages: Does not cause weight gain.
Common side effects: May occasionally cause stomach discomfort and diarrhea.
Cautions: If you have kidney problems, your doctor may prescribe lower doses.
Take at start of meals. Skip the dose if you skip a meal.
Common side effects: Can cause low blood glucose
These medications are generally taken once or twice daily.
Common side effects: These drugs can cause low blood glucose and weight gain.
glyburide, micronized (Glynase® PresTab) Thiazolidinediones (TZDs):
It typically takes 4 to 6 weeks to see an effect on your blood glucose. These drugs are typically Common side effects: Can cause weight gain and fl uid retention.
Heart failure: These drugs can cause heart failure. Call your doctor right away if you have any signs
of heart failure, such as rapid weight gain, shortness of breath, edema (fl uid retention in ankles,
legs, or hands), or fatigue. People with heart failure should not take these drugs.
Liver tests: Your doctor should check your liver function prior to starting these medications and
periodically throughout your treatment. Call your doctor right away if you have any symptoms of liver
damage, such as nausea, vomiting, abdominal pain, fatigue, loss of appetite, or dark urine.
Many people benefi t from taking two or more diabetes drugs, each of which addresses a different See further information for each drug in the combination, listed separately above.
metformin + pioglitazone (Actoplus Met®) rosiglitazone + glimepiride (Avandaryl®) 1. Diabetes Overview. National Diabetes Information Clearinghouse. http://diabetes.niddk.nih.gov/dm/pubs/overview/index.htm#top. Accessed August 14, 2008. 2. Type 2 drugs. American Diabetes Association. http://www.diabetes.org/uedocuments/df-rg-type2-drugs-0108.pdf. Accessed August 14, 2008. 3. Oral diabetes medications. The American Diabetes Association. http://diabetes.org/type-2-diabetes/oral-medications.jsp. Accessed August 14, 2008. 4. Medicines for people with diabetes. National Diabetes Information Clearinghouse. www.niddk.nih.gov/health/diabetes/pubs/med/specific.htm. Accessed August 14, 2008. Copyright 2009 Prescription Solutions. Used with permission. PS0413 5/09.
POLÍTICA DE RESPONSABILIDAD Revisión: 00 SOCIAL Y AMBIENTAL Abril/2013 CONTRATACIÓN DE PROVEEDORES 3.2 De las responsabilidades con el medio ambiente .3 POLÍTICA DE RESPONSABILIDAD Revisión: 00 SOCIAL Y AMBIENTAL Abril/2013 CONTRATACIÓN DE PROVEEDORES 1. Objetivo Formalizar los criterios presentes en las relaciones establecidas por Klabin en las contratacio