Clinical Practice Guideline for Treatment of type 2 Diabetes Mellitus: Therapeutic Targets
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Oct 19, 2017
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Abstract
Introduction: It is demonstrated that reach and maintain a glycated hemoglobin (HbA1c) of 7% reduce the incidence of macro and micro vascular complications in young adults with type 2 diabetes. It has been proposed that this therapeutic goal must be individualized in patients older than 65 years or in those with previous cardiovascular disease, however the evidence supporting this adjustment is controversial. Aim: To define the risk and benefits of intensified therapy to achieve HbA1 <7% in DMT2 patients older than 65 years, with or without significant comorbidities, and in patients with previous cardiovascular events. Methods: A clinical practice guide has been developed following the broad outline of the methodological guide from the Colombian Ministry of Health and Social Welfare, with the aim of systematically gathering scientific evidence and formulating recommendations using the GRADE methodology. Conclusions: In patients with DMT2 who are older than 65 years of age, and in those with antecedents of cardiovascular disease it is recommended not to intensify treatment to reach HbA1c values close to normal (<6,5% HbA1c). The therapeutic goals in patients older than 65 years should be individualized according with an integral evaluation considering hypoglycemia risk and life-threatening situation
Keywords
type 2 diabetes mellitus, goals, clinical practice guidelinesdiabetes mellitus tipo 2, metas, guías de práctica clínica
References
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16. 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.
17. 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.
18. 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.
19. 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.
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21. 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.
22. 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.
23. 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.
24. 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.
25. Anderson RT, Narayan KMV, Feeney P. Effect of intensive glycemic lowering on health-related quality of life in. Diabetes Care. 2011;34:807-12.
26. 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.
27. 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.
28. 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
29. Gómez Huelgas R. Tratamiento de la diabetes tipo 2 en el paciente anciano. Med Clin. 2012;134(3):e1-134.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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).
15. 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.
16. 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.
17. 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.
18. 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.
19. 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.
20. 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.
21. 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.
22. 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.
23. 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.
24. 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.
25. Anderson RT, Narayan KMV, Feeney P. Effect of intensive glycemic lowering on health-related quality of life in. Diabetes Care. 2011;34:807-12.
26. 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.
27. 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.
28. 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
29. Gómez Huelgas R. Tratamiento de la diabetes tipo 2 en el paciente anciano. Med Clin. 2012;134(3):e1-134.
How to Cite
Aschner Montoya, P., Muñoz Velandía, O. M., Girón Cardozo, D. M., García Morales, O. M., Fernández Ávila, D. G., Casas, L. Ángela, Bohórquez Villamizar, L. F., Arango Toro, C. M., Carvajal Gutiérrez, L., Ramírez De Peña, D. A., Sarmiento Ramón, J. G., Colón, C. A., Correa González, N. F., Alarcón Robles, P., & Bustamante, Álvaro A. (2017). Clinical Practice Guideline for Treatment of type 2 Diabetes Mellitus: Therapeutic Targets. Universitas Medica, 58(4). https://doi.org/10.11144/Javeriana.umed58-4.dmmm
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