Documento de abordaje integral de la diabetes tipo 2

Reyes-García, Rebeca; Moreno-Pérez, Óscar; Tejera-Pérez, Cristina; Fernández-García, Diego; Bellido, Virginia; Casares, Martín López de la Torre; Rozas-Moreno, Pedro; Fernández-García, José Carlos; Martínez, Amparo Marco; Escalada, Javier; Gargallo-Fernández, Manuel; Botana-Lopez, Manuel Antonio; López-Fernández, Judith; González-Clemente, José Miguel; Jódar-Gimeno, Esteban; Mezquita-Raya, Pedro

doi:10.1016/j.endinu.2018.10.010

Cited by 28 publications

(14 citation statements)

References 61 publications

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“…Se define carga glucémica evitable como: "La parte del total de la carga glucémica que se obtiene después del primer test HbA 1c lo que mostró un paciente que superó la meta o umbral" HbA 1c resultado de la prueba en el tiempo Modificada de Reach G et al 9 https://doi.org/10.52102/insulina/art-1 con sulfonilureas-insulina con reducciones relativas en el riesgo para cualquier evento relacionado con la diabetes (9 %, p: 0,04), con la enfermedad microvascular (24 %, p: 0,001), reducciones del riesgo de infarto de miocardio (15 %, p: 0,01) y de muerte por cualquier causa (13 %, p: 0,007) 7 .…”

Section: Carga Glucémicaunclassified

“…La mayoría de guías de práctica clínica (GPC) coinciden en que la insulina se debe utilizar en el momento del diagnóstico en personas con marcada hiperglucemia y también se debe utilizar temporalmente durante una enfermedad, embarazo, época de estrés o para un procedimiento médico o cirugía. Este uso intensivo de la terapia con insulina puede conducir a la recuperación parcial de la función de las células beta, cuando se usa en personas con descompensación metabólica, y los estudios sugieren que el tratamiento temprano con insulina puede inducir a la remisión en las personas con diabetes mellitus tipo 2 recién diagnosticada, tras resolver la glucotoxicidad y volver en muchos casos a un régimen terapéutico con antidiabéticos no insulínicos (ADNI) [2][3][4][5][6][7] .…”

Section: Cuándo Insulinizarunclassified

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¿Por qué no insulinizamos cuando es necesario?

Simarro

2021

insulina

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La insulina continúa siendo una piedra angular en el tratamiento de la diabetes mellitus tipo 2 (DM2), ya que la mayoría de las guías de práctica clínica (GPC) la recomiendan cuando no se consiguen los objetivos de control glucémicos con varios antidiabéticos no insulínicos. En la práctica clínica la insulinización se retrasa de manera injustificada, afectando negativamente al pronóstico de la diabetes y aumentando el riesgo de complicaciones. En esta revisión se analizan las barreras que encuentran médicos y pacientes para no intensificar el tratamiento con insulina, así como las herramientas que pueden facilitar un cambio en esta tendencia.

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Section: Carga Glucémicaunclassified

Section: Cuándo Insulinizarunclassified

¿Por qué no insulinizamos cuando es necesario?

Simarro

2021

insulina

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“…National European guidelines recommend similar glycaemic targets for HbA1c as the ADA/EASD consensus (FR HbA1c ≤ 7 % (< 53 mmol/mol) for most people with T2DM [23,24], DE HbA1c 6.5-7.5 % (48-58 mmol/mol) [25,26], IT HbA1c < 6.5 % (< 48 mmol/mol) [27], NL HbA1c ≤ 7 % (≤ 53 mmol/mol) [28], ES HbA1c < 7 % (< 53 mmol/mol) [29] UK HbA1c ≤ 6.5 % (≤ 48 mmol/mol) [30]). Recommendations vary according to patient profiles (age, diabetes duration, comorbidities, therapy related risk for hypoglycaemia; comparison in Table 1).…”

Section: The Level Of Glycaemic Control Of T2dm In Europementioning

confidence: 99%

The burden of type 2 diabetes in Europe: Current and future aspects of insulin treatment from patient and healthcare spending perspectives

Ceriello

deValk

Guerci

et al. 2020

Diabetes Research and Clinical Practice

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Due to the progressive nature of type 2 diabetes (T2DM), initiation of insulin therapy is very likely in the disease continuum. This article aims at highlighting the current situation with regard to insulin therapy in people with T2DM in Europe and at presenting the associated unmet need. Challenges for both people with T2DM and healthcare professionals include clinical inertia also derived from fear of hypoglycaemia, weight gain and injections as well as increased need for a comprehensive diabetes management. We compare national and international guidelines and recommendations for the initiation and intensification of insulin therapy with the real-world situation in six European countries, demonstrating that glycaemic targets are only met in a minority of people with T2DM on insulin therapy. Furthermore, this work evaluates currently recorded numbers of people with T2DM treated with insulin in Europe, the proportion not achieving the stated glycaemic targets and thus in need to enhance insulin therapy e.g. by a change in means of insulin delivery including, but not limited to, insulin pens, wearable mealtime insulin delivery patches, patch pumps, and conventional insulin pumps with continuous subcutaneous insulin infusion. Objectives and MethodologyThe aim of this review is to raise awareness of the status of insulin-treated type 2 diabetes mellitus (T2DM) in Europe. An extensive literature research was conducted on insulin therapy in T2DM, glycaemic targets according to national guidelines, barriers to the initiation of and adherence to insulin therapy as well as costs associated with specific insulin regimens. Country specific data was obtained for six European countries relating to the use of specific insulin regimens in T2DM and the proportion achieving national targets in order to estimate the extent of people inadequately controlled with insulin. Finally, we refer to devices and technologies aimed at improving insulin delivery which may reduce the burden of insulin therapy in those persons sub-optimally controlled.

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“…Therefore, selection of any antihyperglycaemic agents (AHA) for treating these patients must consider the benefit/risk ratio. There are several current guidelines that specifically address the management of T2DM in this population to achieve glycaemic control with minimal risks [1][2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Real-World Clinical Outcomes Associated with Canagliflozin in Patients Aged 65 Years and Older with Type 2 Diabetes Mellitus in Spain: The Old Real-Wecan Study

et al. 2021

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The observational Real-Wecan study showed that canagliflozin 100 mg (CANA100) as an add-on therapy, and canagliflozin 300 (CANA300), switching from prior SGLT-2i therapy, significantly improved several cardiometabolic parameters in patients with T2DM. The aim of this sub-analysis was to assess the effectiveness and safety of canagliflozin in patients aged ≥65 years. The primary outcome of the study was the mean change in HbA1c over the follow-up period. A total of 583 patients met the inclusion criteria (39.5% ≥65 years), 279 in the cohort of CANA100 (36.9% ≥65 years; mean HbA1c 8.05%) and 304 in the cohort of CANA300 (mean age 61.1 years; 41.8% ≥65 years; mean HbA1c 7.51%). In the CANA100 cohort, older patients showed significant reductions in HbA1c (−0.78%) and weight (−4.5 kg). Patients aged ≥65 years switching to CANA300 experienced a significant decrease in HbA1c (−0.27%) and weight (−2.1 kg). There were no significant differences in HbA1c and weight reductions when the cohorts of patients <65 and ≥65 years were compared in a multiple linear regression model. The safety profile of canagliflozin was similar in both age groups. These findings support canagliflozin as an effective therapeutic option for older adults with T2DM.

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Documento de abordaje integral de la diabetes tipo 2

Cited by 28 publications

References 61 publications

¿Por qué no insulinizamos cuando es necesario?

¿Por qué no insulinizamos cuando es necesario?

The burden of type 2 diabetes in Europe: Current and future aspects of insulin treatment from patient and healthcare spending perspectives

Real-World Clinical Outcomes Associated with Canagliflozin in Patients Aged 65 Years and Older with Type 2 Diabetes Mellitus in Spain: The Old Real-Wecan Study

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