Manejo de la hiperglucemia con fármacos no insulínicos en pacientes adultos con diabetes tipo 2

Abstract

ResumenEl adecuado tratamiento de la diabetes mellitus tipo 2 (DM2) incluye la alimentación saludable y el ejercicio (150 min/semana) como pilares básicos. Para el tratamiento farmacológico, la metformina es el fármaco de elección inicial, salvo contraindicación o intolerancia; en caso de mal control, se dispone de 8 familias terapéuticas (6 orales y 2 inyectables) como posibles combinaciones. Se presenta un algoritmo y unas recomendaciones para el tratamiento de la DM2. En prevención secundaria cardiovascular se recomienda asociar un inhibidor del cotransportador sodio-glucosa tipo 2 (iSGLT2) o un agonista del receptor de glucagon-like peptide-1 (arGLP1) en pacientes con obesidad. En prevención primaria, si el paciente presenta obesidad o sobrepeso la metformina deberá combinarse con iSGLT2, arGLP1 o inhibidores de la dipeptidilpeptidasa tipo 4 (iDPP4). Si el paciente no presenta obesidad, podrán emplearse los iDPP4, los iSGLT2 o la gliclazida, sulfonilurea recomendada por su menor tendencia a la hipoglucemia.

GLP-1 RAs in Spain: A Short Narrative Review of Their Use in Real Clinical Practice

“…Apart from the CVD benefit, other guidelines also focus on weight reduction and restrict their use exclusively to patients with high body mass index (BMI) [17]. Yet other guidelines offer a combined approach and advise use of GLP-1 RAs in patients with CVD and/or high BMI [2,[18][19][20]. Guidelines in Spain underscore that the adequate treatment of T2D requires a simultaneous approach to HbA1c, overweight/ obesity, and other CV risk factors such as hypertension, dyslipidaemia or smoking, and highlight that the presence of CVD is a determinant factor for treatment selection [2,21,22].…”

“…Additionally, these studies showed that the time since diagnosis of diabetes to initiation of GLP-1 RAs was greater than 9 years, reflecting long-standing and probably poorly controlled diabetes [28,32]. This is also reflected in the fact that GLP-1 RAs are often used in combination with other glucose-lowering medication such as metformin, insulin, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and sulfonylureas [28], suggesting that they are used in later phases of diabetes and not mainly after metformin, as suggested by guidelines [2,[18][19][20].…”

Actualización sobre insulinas basales disponibles

“…Uno de los retos en el tratamiento de la diabetes mellitus tipo 2 (DM2), en general, y en el tratamiento con insulina especialmente, es evitar la hipoglucemia 1 , siendo esta una complicación propia del tratamiento que ofrecemos y no de la enfermedad.…”

2022 update to the position statement by Primary Care Diabetes Europe: a disease state approach to the pharmacological management of type 2 diabetes in primary care

“…Some general principles, such as avoiding hypoglycaemia, focusing on cardiovascular prevention, individualising control targets, assessing therapeutic adherence, avoiding therapeutic inertia, acknowledging the importance of patient-perceived outcomes (e.g., weight loss), and considering patients' preferences and values, should be considered when treating patients with T2D [43].…”