Esikhathini esifushane kakhulu, imithi yokwehlisa isisindo isishintshe ekubeni umthombo ongaziwa yaba ngesinye sezihloko okuxoxwa ngazo kakhulu emahhovisi odokotela, emakhemisi, nasemibuthanweni yokuxhumana nabantu. Ukwanda kwemithi efana ne-Ozempic, i-Wegovy, ne-Mounjaro kushintsha indlela okukhulunywa ngayo ngokukhuluphala nesifo sikashukela sohlobo 2, futhi umncintiswano wephilisi lokunciphisa isisindo usuyinto ebalulekile ocwaningweni lwezokwelapha. Kodwa-ke, kuvula nempikiswano eyinkimbinkimbi mayelana nokusetshenziswa kwayo, izingozi zayo, nokuthi ubani okufanele ayifinyelele.
Lezi zindlela zokwelapha, eziningi zazo ezisekelwe kuma -agonist e-GLP-1 receptor , zibonise ukwehla kwesisindo okuphawulekayo emtholampilo kanye nezinzuzo ezengeziwe mayelana ne-glucose, impilo yenhliziyo, kanye nengozi yenhliziyo. Kodwa-ke, umthelela wazo udlulela ngale kwesikali: zithinta ezomnotho zezinhlelo zezempilo, imikhuba yokudla, kanye nemibono yomphakathi ngesithombe somzimba kanye nempilo.
Yimiphi imithi emisha yokwehlisa isisindo futhi isebenza kanjani?
Imithi eminingi yokwehlisa isisindo eyaziwa kakhulu inendlela efanayo yokusebenza: ilingisa noma iguqula ukusebenza kwe -glucagon-like peptide-1 (GLP-1) , i-hormone ehilelekile ekulawuleni isifiso sokudla kanye ne-glucose. Lokhu kunjalo nge-semaglutide (Ozempic, Wegovy, Rybelsus) kanye ne-tirzepatide (Mounjaro), ezaqalwa zenzelwe isifo sikashukela sohlobo 2 futhi sezibe ukwelashwa okuhamba phambili kokukhuluphala.
Kubantu abanokukhuluphala ngokweqile kanye nesifo sikashukela, la ma-molecule akhuthaza ukukhishwa kwe-insulin yi-pancreas, akhuthaze ukusebenza kahle kwamaseli e-beta, futhi anciphise ukukhiqizwa kwe-glucagon, okusiza ukugcina amazinga kashukela egazini elawulwa. Ngesikhathi esifanayo, asebenza ohlelweni lwezinzwa oluphakathi kanye nohlelo lokugaya ukudla, ehlisa ukukhishwa kwesisu futhi andise umuzwa wokusutha.
Umphumela uba ukuthi isiguli sivame ukudla kancane ngaphandle kokuzizwa silambile , into ebaluleke kakhulu kulabo abamelana nokuncipha kwesisindo: ubuchopho babo abuqondi kahle umuzwa wokusutha; akuyona nje indaba "yamandla okuzimisela." Kulezi ziguli, ama-GLP-1 inhibitors angaba umlingani obalulekile, uma nje ehlanganiswe ohlelweni oluphelele.
Ngaphezu kokulawula isisindo kanye ne-glucose, izifundo eziningana zikhombisile ukuthi le mithi inciphisa ingozi yezinkinga zenhliziyo , ithuthukisa umfutho wegazi, iphrofayili yamafutha kanye nobubanzi besinqe, okuchaza ukuthi kungani ochwepheshe abaningi bekhuluma ngoshintsho oluyisisekelo endleleni yokukhuluphala.
I-Ozempic, i-Wegovy, i-Mounjaro nezinye izidakamizwa esikhungweni senkulumompikiswano
Phakathi kwemithi yokwehlisa isisindo eyaziwa kakhulu yi- Ozempic , eyasungulwa yinkampani yemithi yaseDenmark iNovo Nordisk isebenzisa i-semaglutide. Nakuba isibonakaliso sayo esivunyiwe singesesifo sikashukela sohlobo 2, isithandwa kakhulu ngemiphumela yayo esisindweni, kwaze kwaba sezingeni lokuba yinto yomphakathi emazweni amaningana.
Ezivivinyweni zemitholampilo ezisezingeni lokugcina, i-semaglutide ejovwayo ifinyelele ukwehla kwesisindo cishe ngo-15% wesisindo somzimba ngemuva konyaka owodwa nje wokwelashwa, uma kuqhathaniswa nokwehla okuncane emaqenjini e-placebo. I-Wegovy, ifomula ye-semaglutide enomthamo ophezulu evunyelwe ngqo ukukhuluphala, ifinyelela amaphesenti amakhulu nakakhulu, idlula u-20% kwezinye izifundo.
Omunye umdlali obalulekile kulolu shintsho lwezokwelapha yiMounjaro ( tirzepatide), ehlanganisa isenzo kuma-receptor e-GLP-1 kanye nenye i-hormone ebizwa ngokuthi i-GIP ku-molecule eyodwa. Ezivivinyweni zemitholampilo, ifinyelele ukwehla kwesisindo okumaphakathi cishe ngo-20% noma ngaphezulu kwezinye iziguli, ngaphezu kokulawulwa kwe-glucose okuthuthukisiwe kakhulu kubantu abanesifo sikashukela sohlobo 2. Kanye neMounjaro, amanye ama-molecule afana ne-retatrutide avele ukuze anciphise isisindo , akha ingxenye yesizukulwane esisha sezindlela zokwelapha ezicwaningwayo.
Kanye nalokhu, kuye kwavela ezinye izindlela ezinefilosofi efanayo: ukuthuthukisa ukusutha, ukulawula ushukela wegazi, nokusiza iziguli ukuthi zidle kancane. I-Rybelsus inikeza i-semaglutide ngesimo sethebhulethi, i-Trulicity (dulaglutide) kanye ne-Victoza (liraglutide) zisetshenziswa kushukela ngethonya elengeziwe esisindweni, kanti i-metformin ihlala iyinsika ekwelapheni isifo sikashukela sohlobo 2 ngethonya elincane esisindweni.
I-WHO iphakamisa izidakamizwa zokwehlisa isisindo zibe ezibalulekile
Isinyathelo esibaluleke kakhulu samazwe ngamazwe sivele kwi- World Health Organization . I-WHO inqume ukufaka ama-agonist e-GLP-1 receptor, asetshenziselwa ukwehlisa isisindo, ohlwini lwayo lwemithi ebalulekile, ikhathalogi echaza ukuthi yiziphi izindlela zokwelapha ezibhekwa njengezibalulekile ekusunguleni uhlelo lokunakekelwa kwempilo oluyisisekelo nolufinyelelekayo.
Embhalweni wezobuchwepheshe oshicilelwe kumagazini i -JAMA , le nhlangano ichaza ukukhuluphala njengesifo esingamahlalakhona nesiphinde sibuye esithinta abantu babo bonke ubudala nezizinda futhi, ezimweni eziningi, sidinga ukwelashwa impilo yonke. Izidakamizwa ezifana ne-Ozempic, i-Wegovy, ne-Mounjaro zibhekwa njengethuluzi elikwazi ukukhiqiza ukwehla kwesisindo okubalulekile emtholampilo nokunikeza izinzuzo ezibanzi ze-metabolic.
Kodwa-ke, i-WHO igcizelela ukuthi le mithi inengqondo kuphela uma ihlanganiswe ezinhlelweni ezijulile zokushintsha indlela yokuphila . Iziqondiso zayo zigcizelela ukuthi kufanele zisetshenziswe kubantu abadala abanokukhuluphala ngokweqile (ngaphandle kwabesifazane abakhulelwe) njengokwelashwa kwesikhathi eside, njalo ngaphansi kokubhekwa kwezokwelapha futhi kuhlanganiswe nokungenelela kokuziphatha: ukudla okunempilo, umsebenzi womzimba oguquliwe, kanye nokusekelwa kwengqondo uma kudingeka.
Umyalezo oyinhloko ucacile: imithi ingasiza izigidi zabantu ukuphatha ukukhuluphala futhi inciphise izinkinga zakho, kodwa akwanele ngokwayo ukuxazulula inkinga yokukhuluphala emhlabeni wonke . Kusalokhu kungabaza ngokuphepha kwesikhathi eside, izindleko eziphakeme zokwelapha, kanye nekhono lamazwe lokuqinisekisa ukufinyelela okulinganayo.
I-WHO ngokwayo ixwayisa ngokuthi, ngaphandle kwezinqubomgomo zokuvimbela kanye nokukhuthaza impilo ngesikhathi esifanayo, ukusetshenziswa okukhulu kwale mithi kungabhebhethekisa ukungalingani kwezempilo , kushiye ukwelashwa ezandleni zalabo abangakwazi ukukukhokhela futhi kukhishwe abantu abasengozini enkulu.
ISpain kanye noxhaso lomphakathi: ukungqubuzana phakathi kwezincomo zomhlaba jikelele kanye neqiniso
Impikiswano ephathelene nemithi yokwehlisa isisindo iyinto ehluke kakhulu eSpain. Nakuba i-WHO izibeka njengemithi "ebalulekile", uMnyango Wezempilo ugcina isimo esinqunyiwe mayelana nokuxhaswa kwayo ngaphakathi kweNational Health System (NHS), ikakhulukazi mayelana nokusetshenziswa kwayo njengokwelapha ukukhuluphala.
Endabeni ye -Ozempic , i-semaglutide imbozwa yi-Spanish National Health System kuphela njengokwelashwa okukodwa kwesifo sikashukela sohlobo lwesibili ngaphansi kwezimo ezithile zezokwelapha. Imithi yayo yokwehlisa isisindo ayimbozwa umshwalense womphakathi, ngakho labo abafisa ukuyisebenzisa ngale njongo kumele bakhokhe izindleko ezigcwele ekhemisi.
I-Mounjaro , esanda kungena emakethe yaseSpain, izithola isesimweni esifanayo: naphezu kwamandla ayo okwelapha ukukhuluphala, ayikakambozwa yizinzuzo zemithi ze-National Health System . I-Interministerial Commission on Drug Prices iphinde yagcizelela ukwenqaba kwayo ukuxhasa ama-semiglutide formulations ahloselwe ngqo ukukhuluphala, njenge-Wegovy, iphawula umthelela omkhulu kakhulu wesabelomali. Ngaphezu kwalokho, kunezixwayiso mayelana nokwanda kwemithi yokwehlisa isisindo engekho emthethweni, okwenza kube nzima nakakhulu ukulawula.
Impikiswano ebalulekile evezwe uMnyango Wezempilo isidingo "sokulungisa ukusetshenziswa kwemithi yomphakathi " nokuvikela ukuzinza kohlelo. Ukube i-semaglutide ibixhaswe ngezimali zokunciphisa isisindo ngaphandle kwemingcele, inani labasebenzisi abangaba khona beliyoba likhulu kakhulu, okuholela ezindlekweni eziphakeme kakhulu zonyaka ezimalini zomphakathi.
Lesi sinqumo singqubuzana nesimo se-WHO kanye nombono wochwepheshe abaningi, abathi ukukhuluphala kufanele kubhekwe njengesifo esingamahlalakhona kanye nokufinyelela okulinganayo ekwelashweni kuqinisekiswe, ngaphandle komehluko phakathi kwemiphakathi ezimele noma ukungalingani kwezomnotho. Iqiniso namuhla ukuthi ingxenye enkulu yale mithi isasele emkhakheni ozimele, okuphakamisa umbuzo oyisisekelo mayelana nohlobo lwemodeli yezempilo esifuna ukuyakha.
Ama-molecule amasha omlomo: i-Orforglipron nesizukulwane esilandelayo
Nakuba imijovo ithatha indawo yezindaba, ucwaningo lwemithi luyaqhubeka nokuqhubekela phambili ekukhetheni okusetshenziswa ngomlomo okulula kakhulu . Isibonelo esisodwa yi -Orforglipron , i-agonist ye-GLP-1 receptor, ngokungafani ne-semaglutide noma i-tirzepatide, engeyona iphrotheni. Lokhu kuvumela ukwakheka kwethebhulethi okunezici ezihlukile.
Ngokusho kwedatha etholakalayo, lo muthi osathuthukiswayo unikeza ukutholakala okukhulu komuthi ngomlomo ngaphandle kwemikhawulo yokudla , okusho ukuthi iziguli zingawuthatha ngaphandle kwesidingo sokuwuhlanganisa nokudla okuthile noma ukulandela imiyalelo eqinile yokuzila ukudla. Lokhu kulula kokuphathwa kungathuthukisa kakhulu ukunamathela ekwelashweni.
Izifundo zokuqala zisikisela ukuthi i-Orforglipron yehlisa isisindo somzimba cishe ngo-8% ngemithamo ephezulu kakhulu. Nakuba lokhu kuphansi kuneminye imijovo enamandla, ezimweni zokukhuluphala okulinganiselwe noma ezigulini ezingadingi ukwehla okukhulu kangaka, kungaba umphumela ongcono kakhulu, ikakhulukazi uma ucabangela ukulula kokuthatha iphilisi.
Ngaphezu komphumela waso esisindweni, lo muthi omusha ocwaningwayo ubonise ukuthuthuka kwesifo sikashukela sohlobo 2 : ukwehla kwe-hemoglobin ye-glycosylated, ukulawulwa okungcono kwe-glucose, kanye nokwehla kwezici eziyingozi zenhliziyo, njengomfutho wegazi ophakeme noma i-cholesterol ephezulu.
Ngokuphathelene nephrofayili yayo yokuphepha , idatha yokuqala ikhombisa ukuthi imiphumela emibi evame kakhulu ukugaywa kwamathumbu (isicanucanu, ukungakhululeki kwamathumbu), okuhambisana nalokho okubonwe kweminye imithi ekilasini elifanayo, futhi azikho izinkinga ezinkulu ezitholakele ezivivinyweni ezishicilelwe kuze kube manje. Kunoma ikuphi, umuthi ongakathengiswa, olinde ukuhlolwa yizikhungo ezilawulayo.
Ubani ongasebenzisa le mithi futhi ngaphansi kwaziphi izimo
Enye yezinkinga ezibucayi kakhulu ukuchaza ukuthi ubani ngempela ofanelekela imithi yokwehlisa isisindo . Ochwepheshe bagcizelela ukuthi lokhu akuyona imikhiqizo esetshenziswayo yokwehlisa “amakhilogremu ambalwa” ngezizathu zobuhle, kodwa kunalokho ukwelashwa okungathi sína kwemithi okufanele kugcinelwe izimo ezichazwe kahle.
Emkhakheni wokukhuluphala, le mithi ihloselwe kakhulu abantu abanokukhuluphala ngokweqile, isifo sikashukela sohlobo 2, noma ingozi ephezulu yenhliziyo , lapho isisindo esiningi sihlotshaniswa khona nokwehla kwempilo. Ukusetshenziswa kwayo kumele kube okungapheli, okusho ukuthi kuqhubeke isikhathi eside, futhi kuhambisane nokudla okulinganiselayo kanye nomsebenzi womzimba ofanele.
Odokotela be-endocrinologists kanye nemiphakathi yesayensi bagcizelela ukuthi lokhu akuyona imithi "yokunciphisa umzimba" ehlobo, noma kulabo abafuna nje ukuthuthukisa ukubukeka kwabo ngaphandle kwenkinga yempilo eyisisekelo. Ukuyinika abantu abaphilile kubhekwa njengokungasebenzi kahle, futhi ngamazwi abanye ochwepheshe, "kuyihlazo."
Ngaphezu kwalokho, bagcizelela ukuthi ukuqapha kwezokwelapha kubalulekile ekulungiseni umthamo, ukuqapha imiphumela emibi, kanye nokusekela isiguli ekushintsheni indlela yaso yokuphila. Kwezinye izimo, uma ukwelashwa kuyekwa ngaphandle kokusungula indlela yokuphila enempilo, ingozi yokuphinda uthole isisindo esilahlekile iyanda, futhi kungenzeka kube nomphumela owesabekayo "we-yo-yo".
Ngokuphathelene nezindleko, kusenokungaqiniseki okukhulu. Imithi esakhiwayo, njenge-Orforglipron, ingaba ishibhile kunemithi yokujova yamanje , kodwa kuze kube yilapho ithengiswa futhi ihlolwe yi-ejensi yokulawula, ngeke kwaziwe ukuthi izombozwa yini, yiziphi izinkomba, futhi ngaphansi kwaziphi izimo.
Imiphumela emibi, ukuphepha, kanye nemibuzo evelele
Naphezu kwezinzuzo, ukusetshenziswa kabanzi kwemithi yokwehlisa isisindo kuye kwaveza imiphumela emibi eminingana kanye nezingozi ezisacwaningwa. Ezivame kakhulu ukugaya ukudla: isicanucanu, ukuhlanza, isifo sohudo, noma ukungakhululeki esiswini, ikakhulukazi ekuqaleni kokwelashwa noma ngemithamo eyengeziwe.
Ngaphandle kwalokhu kungakhululeki, abanye ochwepheshe bagxile ekulahlekelweni kwemisipha okungahambisana nokwehla kwesisindo uma isiguli singadli amaprotheni anele noma singaqeqeshi ngamandla. Lapho umzimba unciphisa kakhulu ukudla kwawo, awushisi nje kuphela amafutha kodwa futhi ungaphula izicubu zemisipha, okubangela ukwehla kwesilinganiso se-basal metabolic.
Lesi simo singaholela ekunciphiseni isisindo ngokushesha, kodwa uma kukhona ukulahleka okukhulu kwemisipha, ingozi yokuphinda uthole isisindo esilahlekile iyanda . Ngakho-ke, odokotela be-endocrinologists kanye nochwepheshe bezokudla bagcizelela ukubaluleka kokugcina ukudla okunamaprotheni anele kanye nokufaka ukuzivocavoca ukuze kulondolozwe imisipha.
Kuye kwabikwa nezinkinga zamehlo ezingavamile , njengezimo ezithile ezingalimaza i-retina. Ucwaningo olulodwa lwezinkulungwane zeziguli lubone ukwanda okukhulu kwesifo samehlo esibi kulabo abathatha i-semaglutide, yize ubudlelwano obuqondile bembangela bungazange buqinisekiswe futhi inani lamacala lalilincane. Noma kunjalo, kwanele ukuphakamisa ukukhathazeka okuthile kanye nokucela ukuqaphela.
Iziphathimandla zezempilo zikhomba ukuthi lezi izindlela zokwelapha ezintsha, ngakho-ke isithombe esiphelele sokuphepha kwazo kwesikhathi eside asikatholakali . Ngenxa yalesi sizathu, i-WHO igcizelela isidingo sokubuyekezwa okuqhubekayo kwezinkombandlela zokusebenzisa njengoba kuvela ubufakazi obusha nokuthi iziguli ziqashwe ngokucophelela ochwepheshe bezempilo.
Ukushintsha imikhuba, imboni, kanye nombono womphakathi wesisindo
Ukwanda kwemithi yokwehlisa isisindo akugcini nje ngokubangela imiphumela yezokwelapha; kodwa futhi kushintsha imikhuba yokusebenzisa kanye nemibono yomphakathi . E-United States, isibonelo, izinkampani ezinkulu ezifana ne-Walmart sezivele zibonile ukuthi amakhasimende athenga i-semaglutide avame ukuthenga imikhiqizo embalwa enama-calorie amaningi, futhi ngokuvamile, ukudla okuncane.
Ngokuhamba kwesikhathi, lolu hlobo lwezinguquko lungathinta izitolo ezinkulu, izindawo zokudlela, kanye nezitolo zokudla okusheshayo uma ingxenye enkulu yabantu inciphisa ukudla kwayo okunama-calorie ngenxa yalezi zindlela zokwelapha. Ezinye izilinganiso zisikisela ukuthi eminyakeni ezayo, ingxenye enkulu yabantu ingase ithathe imithi yokukhuluphala ngokweqile, into imboni yokudla eyiqapha eduze.
Okwamanje, ingxoxo yomphakathi ngalezi zidakamizwa ixhumene nempikiswano ebanzi mayelana nezindinganiso zobuhle, izinkundla zokuxhumana, kanye nempilo yengqondo . Amazwi avela emkhakheni wamasiko abuze ukusetshenziswa kabanzi kwemithi ukuze kuhambisane nemigomo ethile yobuhle, exwayisa ngokuthi ukugxila emzimbeni kungafihla ukungaqiniseki okujulile noma izinkinga zokuzethemba.
Ngokombono wezokwelapha, ochwepheshe abaningi baphikelela ekuhlukaniseni phakathi kwezinkinga ezimbili: ukwelapha isifo esingamahlalakhona njengokukhuluphala ngokweqile , okunemiphumela emibi empilweni, kuyinto eyodwa, kodwa ukusebenzisa le mithi njengesixazululo esisheshayo sokufinyelela umzimba ofanele kuyinto ehlukile kakhulu. Kulesi simo sesibili, ingozi yokululaza imithi nokungaqapheli imiphumela yayo emibi inkulu kakhulu.
Ukwanda kwama-agonist e-GLP-1 kusiphoqa ukuthi sicabange kabusha hhayi nje kuphela ngendlela esiphatha ngayo ukukhuluphala, kodwa futhi nendlela esiqonda ngayo isisindo, isithombe somzimba kanye nobudlelwano nokudla emphakathini ochayeke kakhulu emilayezweni ephikisanayo mayelana nempilo nokubukeka.
Ukuvela kwemithi yokwehlisa isisindo kuphawula uguquko ekwelapheni ukukhuluphala kanye nesifo sikashukela sohlobo 2. Le mithi ingafeza ukwehla okukhulu kwesisindo futhi ithuthukise amaphrofayili e-metabolic, kodwa iphakamisa imibuzo mayelana nokuphepha kwayo kwesikhathi eside, ukusetshenziswa kwayo okunesibopho, kanye nokuxhaswa ngezimali. Ngenkathi i-WHO iziphakamisa zibe yimithi ebalulekile futhi ifuna ukuhlanganiswa kwayo emasu aphelele ezempilo yomphakathi, amazwe afana neSpain ayanqikaza ukuzifaka ezinhlelweni zawo zokunakekelwa kwempilo ezixhaswe ngumphakathi, okudala impikiswano ehlanganisa isayensi, ezomnotho, kanye nokuziphatha. Kulesi simo esisha, isihluthulelo sibonakala sisekutholeni ibhalansi: ukusebenzisa le mithi kuphela uma kuboniswe ngempela, ngokuqapha kochwepheshe futhi kuhambisana nezinguquko zendlela yokuphila , ukugwema kokubili ukukhohliswa kwayo kanye nokusetshenziswa kwayo okungabalulekile, kanye nokubeka impilo yabantu phambili njalo.
