Guía de práctica clínica para el tratamiento de la diabetes mellitus tipo 2: metas de manejo

Pablo Aschner Montoya, Oscar Mauricio Muñoz Velandía, Diana Marcela Girón Cardozo, Olga Milena García Morales, Daniel Gerardo Fernández Ávila, Luz Ángela Casas, Luisa Fernanda Bohórquez Villamizar, Clara Maria Arango Toro, Liliana Carvajal Gutiérrez, Doris Amanda Ramírez De Peña, Juan Guillermo Sarmiento Ramón, Cristian Alejandro Colón, Nestor Fabian Correa González, Pilar Alarcón Robles, Álvaro Andrés Bustamante

Resumen


Resumen

Introducción: Está demostrado que alcanzar y mantener una hemoglobina glicosilada (HbA1c) del 7 % reduce la incidencia de complicaciones micro y macrovasculares en adultos jóvenes con diabetes mellitus tipo 2 (DMT2). Se ha propuesto que esta meta de manejo debe individualizarse en pacientes mayores de 65 años de edad o en aquellos con antecedente de enfermedad cardiovascular; sin embargo, la evidencia es discutida. Objetivos: Definir los potenciales riesgos y beneficios de la terapia intensificada para DMT2 buscando valores de HbA1 < 7 % en pacientes mayores de 65 años, con comorbilidades significativas y sin estas, y en grupos de pacientes con eventos cardiovasculares previos. Métodos: Se elaboró la guía de práctica clínica, siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social colombiano. Se revisó la evidencia disponible de forma sistemática y se formularon las recomendaciones utilizando la metodología GRADE. Conclusiones: En los pacientes con DMT2 mayores de 65 años y en aquellos con antecedente de enfermedad cardiovascular, se recomienda no intensificar el manejo para alcanzar valores de HbA1c cercanos a lo normal (< 6,5 %). Las metas de manejo en el grupo de mayores de 65 años deberán definirse para cada paciente de forma individual de acuerdo con una valoración integral que tenga en cuenta su riesgo de hipoglucemia y pronóstico vital.

 


Palabras clave


diabetes mellitus tipo 2;metas;guías de práctica clínica

Referencias


Aschner PJ, Ruiz AJ. Metabolic memory for vascular disease in diabetes. Diabetes Technol Ther. 2012 Jun;14 Suppl 1:S68-74.

Prospective Diabetes Study Gruup. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-53.

Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep;352(9131):854-65.

Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008 Oct;359(15):1577-89.

Gerstein HC, Miller ME, Byington RP, Goff DC, Bigger JT, Buse JB, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008 Jun;358(24):2545-59.

Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008 Jun;358(24):2560-72.

Duckworth W, Abraira C, Moritz T, Reda D, Emanuele N, Reaven PD, et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009 Jan;360(2):129-39.

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycaemia in type 2 diabetes: a patient-centered approach. Position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2012 Jun;55(6):1577-96.

Sinclair A, Paolisso G, Castro M, Bourdel I, Gadsby R, Rodriguez L. European Diabetes Working Party for Older People 2011 clinical guidelines for type 2 diabetes mellitus (EDWPOP). Diabetes Metab. 2011;37(3):s27-38.

Hewitt J, Smeeth L, Chaturvedi N, Bulpitt CJ, Fletcher a E. Self management and patient understanding of diabetes in the older person. Diabet Med. 2011 Jan;28(1):117-22.

Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl J Med. 2011 Mar 3;364(9):829-41.

Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, et al. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34(39):3035-87.

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35(6):1364-79.

Riethof M, Pl F, Lindvall B, Michels R, Connor OP, Redmon B, et al. Diagnosis and Management of type 2 diabetes mellitus in adults. ICSI. 2012;(April).

Boussageon R, Bejan-Angoulvant T, Saadatian-Elahi M, Lafont S, Bergeonneau C, Kassaï B, et al. Effect of intensive glucose lowering treatment on all cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: meta-analysis of randomised controlled trials. BMJ. 2011 Jan;343:d4169.

Buehler AM, Cavalcanti AB, Berwanger O, Figueiro M, Laranjeira LN, Zazula AD, et al. Effect of tight blood glucose control versus conventional control in patients with type 2 diabetes mellitus: a systematic review with meta-analysis of randomized controlled trials. Cardiovasc Ther. 2013 Jun;31(3):147-60.

Coca S, Faramarz I, Nowreen H. Role of intensive glucose control in development of renal end points in type 2 diabetes mellitus. Arch Intern Med. 2012;172(10):761-9.

Hemmingsen B, Lund SS, Gluud C, Vaag A, Almdal T, Hemmingsen C, et al. Intensive glycaemic control for patients with type 2 diabetes: systematic review with meta-analysis and trial sequential analysis of randomised clinical trials. BMJ. 2011 Jan;343(November):d6898.

Ray KK, Seshasai SRK, Wijesuriya S, Sivakumaran R, Nethercott S, Preiss D, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet. Elsevier Ltd; 2009 May 23;373(9677):1765-72.

Zhang C, Zhou Y-H, Xu C-L, Chi F-L, Ju H-N. Efficacy of intensive control of glucose in stroke prevention: a meta-analysis of data from 59,197 participants in 9 randomized controlled trials. PLoS One. 2013 Jan;8(1):e54465.

Miller ME, Williamson J, Gerstein H. Effects of randomization to intensive glucose control on adverse events, cardiovascular disease and mortality in older versus younger adults in the ACCORD trial. Diabetes Care. 2014;37(3):634-43.

Anderson RT, Narayan KMV, Feeney P, Goff D, Ali MK, Simmons DL, et al. Effect of intensive glycemic lowering on health-related quality of life in type 2 diabetes: ACCORD trial. Diabetes Care. 2011 Apr;34(4):807-12.

Hemmingsen B, Lund S, Gluud C, Vaag A, Almdal T, Hemmingsen C, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2013;Nov 11;11:CD008143. doi: 10,1002/14651858.

Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009;52(11):2288-98.

Anderson RT, Narayan KMV, Feeney P. Effect of intensive glycemic lowering on health-related quality of life in. Diabetes Care. 2011;34:807-12.

Mannucci E, Monami M, Lamanna C, Gori F, Marchionni N. Prevention of cardiovascular disease through glycemic control in type 2 diabetes: A meta-analysis of randomized clinical trials. Nutr Metab Cardiovasc Dis. 2009;19(9):604-12.

European Diabetes Working Party for Older People working Group. European Diabetes Working Party for Older People 2011 Clinical Guidelines for Type 2 Diabetes Mellitus (EDWPOP). Diabetes Metab. 2011;37(3):S27-38.

Guideline Group. International Diabetes Federation. Managing older people with type 2 diabetes. 2004 [internet]. Disponible en: https://www.idf.org/sites/default/files/IDF %20Guideline %20for %20Older %20People.pdf

Gómez Huelgas R. Tratamiento de la diabetes tipo 2 en el paciente anciano. Med Clin. 2012;134(3):e1-134.




DOI: http://dx.doi.org/10.11144/Javeriana.umed58-4.dmmm

Métricas de artículo

Cargando métricas ...

Metrics powered by PLOS ALM




Copyright (c) 2017 Pablo Aschner Montoya, Oscar Mauricio Muñoz Velandía, Diana Marcela Girón Cardozo, Olga Milena García Morales, Daniel Gerardo Fernández Ávila, Luz Ángela Casas, Luisa Fernanda Bohórquez Villamizar, Clara Maria Arango Toro, Liliana Carvajal Gutiérrez, Doris Amanda Ramírez De Peña, Juan Guillermo Sarmiento Ramón, Cristian Alejandro Colón, Nestor Fabian Correa González, Pilar Alarcón Robles, Álvaro Andrés Bustamante

Licencia de Creative Commons
Esta obra está registrada bajo una licencia de Creative Commons Reconocimiento 4.0 Internacional.
Creado a partir de http://revistas.javeriana.edu.co/.