Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2

Torre, Edelmiro Menéndez; Tejedor, Francisco Javier Lafita; Menéndez, Sara Artola; Núñez-Cortés, Jesús Millán; García, Ángeles; Puig-Domingo, Manel; Solans, José Ramón García; Guisasola, Fernando Álvarez; Alegría, Javier García; Bravo, José Javier Mediavilla; Fernández-Santos, Carlos Miranda; Romero, R.

doi:10.1016/j.aprim.2010.07.012

Cited by 20 publications

(11 citation statements)

References 78 publications

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“…if they meet glycemic targets to reduce the risk of micro- and macrovascular complications [8–10]. In line with other guidelines, Spanish treatment guidelines recommend glycated hemoglobin (HbA1c) target levels of <6.5% (47.5 mmol/mol) if patients are newly diagnosed with type 2 diabetes, younger than 70 years and without diabetes-related complications, and <7.5% (58.5 mmol/mol) otherwise [11]. However, only 32 and 68% of Spanish patients are reaching HbA1c levels of <6.5% (47.5 mmol/mol) and <7.5% (58.5 mmol/mol), respectively, and only 55% of patients are adequately controlled with respect to individualized glycemic targets [12].…”

Section: Introductionmentioning

confidence: 99%

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Liraglutide Versus Lixisenatide: Long-Term Cost-Effectiveness of GLP-1 Receptor Agonist Therapy for the Treatment of Type 2 Diabetes in Spain

Mezquita-Raya

Arellano²,

Kragh

et al. 2017

Diabetes Ther

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Introduction Glucagon-like peptide-1 (GLP-1) receptor agonists are used successfully in the treatment of patients with type 2 diabetes as they are associated with low hypoglycemia rates, weight loss and improved glycemic control. This study compared, in the Spanish setting, the cost-effectiveness of liraglutide 1.8 mg versus lixisenatide 20 μg, both GLP-1 receptor agonists, for patients with type 2 diabetes who had not achieved glycemic control targets on metformin monotherapy.MethodsThe IMS CORE Diabetes Model was used to project clinical outcomes and costs, expressed in 2015 Euros, over patient lifetimes. Baseline cohort data and treatment effects were taken from the 26-week, open-label LIRA-LIXI™ trial (NCT01973231). Treatment and management costs of diabetes-related complications were retrieved from published sources and databases. Future benefits and costs were discounted by 3% annually. Sensitivity analyses were conducted.ResultsCompared with lixisenatide 20 μg, liraglutide 1.8 mg was associated with higher life expectancy (14.42 vs. 14.29 years), higher quality-adjusted life expectancy [9.40 versus 9.26 quality-adjusted life years (QALYs)] and a reduced incidence of diabetes-related complications. Higher acquisition costs resulted in higher total costs for liraglutide 1.8 mg (EUR 42,689) than for lixisenatide 20 μg (EUR 42,143), but these were partly offset by reduced costs of treating diabetes-related complications (EUR 29,613 vs. EUR 30,636). Projected clinical outcomes and costs resulted in an incremental cost-effectiveness ratio of EUR 4113 per QALY gained for liraglutide 1.8 mg versus lixisenatide 20 μg.ConclusionsLong-term projections in the Spanish setting suggest that liraglutide 1.8 mg is likely to be cost-effective compared with lixisenatide 20 μg in type 2 diabetes patients who have not achieved glycemic control targets on metformin monotherapy. Liraglutide 1.8 mg presents a clinically and economically attractive treatment option in the Spanish setting.

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Section: Introductionmentioning

confidence: 99%

“…The Spanish Diabetes Society recommends the use of metformin as the first-line pharmaceutical therapy for patients with type 2 diabetes and an HbA1c level of ≤8.5% (69.4 mmol/mol) [11]. If treatment targets are not met within 3 months, second-line treatments should be added.…”

Section: Introductionmentioning

confidence: 99%

Liraglutide Versus Lixisenatide: Long-Term Cost-Effectiveness of GLP-1 Receptor Agonist Therapy for the Treatment of Type 2 Diabetes in Spain

Mezquita-Raya

Arellano²,

Kragh

et al. 2017

Diabetes Ther

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“…Por todo lo anterior, la glibenclamida está explícitamente desaconsejada en la mayor parte de las guías y ante esta realidad y teniendo en cuenta la eficacia, seguridad y bajo costo de la gliclazida y glimepirida, la terapia con estas sulfonilureas debe ser considerada como segunda línea después de la metformina en países de bajos ingresos económicos en reemplazo de la glibenclamida 31 .…”

Section: Discussionunclassified

Evaluación de la prescripción de glibenclamida en diabéticos tipo 2

Castro¹,

Estrada

Goez

2017

revsal

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RESUMENIntroducción: Las sulfonilureas permanecen junto con la metformina como el tratamiento farmacológico más usado para los pacientes diabéticos tipo 2, y continúan siendo los antidiabéticos más prescritos en algunas regiones del mundo. Objetivo: Evaluar la prescripción de glibenclamida en aspectos relacionados a contraindicaciones, dosificación, y prevención de efectos adversos, en el tratamiento de los pacientes diabéticos tipo 2 que acuden a una institución de salud de baja complejidad en Cartagena de Indias, Colombia. Metodología: Estudio descriptivo con enfoque desde la fármaco-epidemiología dirigido específicamente al campo de los estudios de utilización de medicamentos, basado en los datos recogidos mediante revisión de historias clínicas de 331 pacientes diabéticos tipo 2, mayores de 18 años en un centro de atención primaria en salud de la ciudad de Cartagena de Indias entre los años 2013 y 2014. Se estudiaron variables demográficas, clínicas y paraclínicas, el esquema terapéutico y la calidad de la prescripción. La información se analizó usando estadística descriptiva. Resultados: 57 % (189) de los pacientes utilizaron glibenclamida siendo un 59.3 % (153) prescrito de manera inadecuada, 45.5% (86) tenían alguna contraindicación para el empleo del medicamento. En 1 % de los pacientes de la muestra se prescribió sobrepasando el rango de dosis terapéutica Conclusiones: La calidad de la prescripción de la glibenclamida fue inadecuada en una proporción importante de pacientes, se hace necesario implementar estrategias educacionales que capaciten al personal médico para una correcta utilización de los fármacos antidiabéticos. La glibenclamida comparada con otras sulfonilureas de segunda generación nos brinda más desventajas que ventajas.Palabras Clave: Diabetes Mellitus Tipo 2, glibenclamida, contraindicaciones, tasa de filtración glomerular, prescripciones de medicamentos, farmacoepidemiología. ABSTRACTIntroduction: Sulfonylureas remain with metformin as the most used drug treatment for type 2 diabetic patients and remain the most prescribed anti-diabetic in some regions of the world. Target: Evaluate prescribing glyburide in aspects related to contraindications, dosage, and prevention of adverse effects, in the treatment of type 2 diabetic patients attending a health institution low complexity in Cartagena de Indias, Colombia. Methodology: Descriptive study with approach from the pharmaco-epidemiology specifically directed to the field of studies of drug use, based on the data collected through review of medical records of 331 type 2 diabetic patients over 18 years in a primary

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“…We identified clinical variables used in the ADA/EASD [ 2 ] and SED consensus [ 3 ]. Young age was considered ≤70 and ≤75 years for the SED and ADA/EASD strategies, respectively, whereas long duration of diabetes was defined as > 10 years for both strategies.…”

Section: Methodsmentioning

confidence: 99%

“…On the other hand, a more stringent target such as HbA1c <6.5 % (48 mmol/mol) was considered beneficial in younger patients without comorbid conditions and with no adverse effects of antihyperglycemic treatment. Similarly, the national consensus from the Sociedad Española de Diabetes (SED – Spanish Diabetes Society) [ 3 ] recommended a stringent HbA1c target of <6.5 % (48 mmol/mol) in patients with newly diagnosed diabetes, age <70 years, and absence of diabetic complications, otherwise, a less stringent HbA1c goal of <7.5 % (58 mmol/mol) should be the target in the absence of these conditions. The American Association of Clinical Endocrinologists (AACE) also recommends the individualization of glycemic targets taking into account several factors that include concurrent illnesses and risk of hypoglycemia [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain

et al. 2016

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BackgroundInformation about the achievement of glycemic targets in patients with type 2 diabetes according to different individualization strategies is scarce. Our aim was to analyze the allocation of type 2 diabetic patients into individualized glycemic targets according to different strategies of individualization and to assess the degree of achievement of adequate control.MethodsCross-sectional analysis on 5382 type 2 diabetic patients in primary care setting in Spain between 2011 and 2012. Targets of HbA1c were assigned based on different strategies of individualization of glycemic targets: 1) the ADA/EASD consensus 2) The Spanish Diabetes Society (SED) consensus 3) a strategy that accounts for the risk of hypoglycemia (HYPO) considering the presence of a hypoglycemia during the last year and type of hypoglycemic treatment. Concordance between the different strategies was analyzed.ResultsA total of 15.9, 17.1 and 67 % applied to ADA/EASD recommendation of HbA1c target of <6.5, < 7 and <8 % (48, 53 and 64 mmol/mol), and 31.9 and 67.4 % applied to the SED glycemic target of <6.5 and <7.5 % (<48 and 58 mmol/mol). Using the HYPO strategy, 53.5 % had a recommended HbA1c target <7 % (53 mmol/mol). There is a 94 % concordance between the ADA/EASD and SED strategies, and a concordance of 41–42 % between these strategies and HYPO strategy. Using the three different strategies, the overall proportion of patients achieving glycemic targets was 56–68 %.ConclusionsIndividualization of glycemic targets increases the number of patients who are considered adequately controlled. The proposed HYPO strategy identifies a similar proportion of patients that achieve adequate glycemic control than ADA/EASD or SED strategies, but its concordance with these strategies in terms of patient classification is bad.

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Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2

Cited by 20 publications

References 78 publications

Liraglutide Versus Lixisenatide: Long-Term Cost-Effectiveness of GLP-1 Receptor Agonist Therapy for the Treatment of Type 2 Diabetes in Spain

Liraglutide Versus Lixisenatide: Long-Term Cost-Effectiveness of GLP-1 Receptor Agonist Therapy for the Treatment of Type 2 Diabetes in Spain

Evaluación de la prescripción de glibenclamida en diabéticos tipo 2

Meeting individualized glycemic targets in primary care patients with type 2 diabetes in Spain

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