El tratamiento de la diabetes mellitus (DM) se debe considerar siempre de manera intensificada, ya que ésta ha sido la única forma que ha demostrado disminuir la morbilidad y la mortalidad. Dentro de la diabetes se distinguen dos tipos principales, pero la diabetes mellitus tipo 2 se diagnostica en el 90% de los casos y, por tanto, es el principal objetivo del presente suplemento. El tratamiento de la diabetes mellitus tipo 2 incluye, además de las lógicas modificaciones dietéticas y del estilo de vida, un abanico más o menos amplio de fármacos orales e insulinas. En las fases iniciales será suficiente con antidiabéticos orales dirigidos siempre a disminuir la resistencia a la insulina, para añadir con posterioridad, si se precisa, un fármaco secretagogo. Más adelante será necesario iniciar la administración de insulina para cubrir el deficit de función beta. Inicialmente se utilizará una pauta de insulina basal para, en estadios más avanzados de la enfermedad, recurrir a pautas intensificadas con multiples dosis de insulina, de manera similar a como se procede en la DM tipo 1 ya desde el diagnóstico.
Palabras clave
Diabetes mellitus
Antidiabéticos orales
Tratamiento con insulina
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Bibliografía
[1.]
UKPDS Group.
Overview of six years’ therapy of type 2 diabetes: a progressive disease (UKPDS 16).
Diabetes, (1995), 44 pp. 1249-1258
[2.]
R.R. Holman.
Analysis of the United Kingdom Prospective Diabetes Study.
Diabetes Res Clin Prac, (1998), 40 pp. S21-S25
[3.]
K.C. Chiu, N.P. Lee, P. Cohan, L.M. Chuang.
Beta cell function declines with age in glucose tolerant Caucasians.
Clin Endocrinol, (2000), 53 pp. 569-575
[4.]
G. Boden, G.I. Shulman.
Free fatty acids in obesity and type 2 diabetes: defining their role in the development of insulin resistance and ß-cell dysfunction.
Eur J Clin Invest, (2002), 32 pp. 14-23
[5.]
N. Kaiser, G. Leibowitz, R. Nesher.
Glucotoxicity and beta-cell failure in type 2 diabetes mellitus.
J Pediatr Endocrinol Metab, (2003), 16 pp. 5-22
[6.]
M. Stumvoll, B. Goldstein, T. Van Haelten.
Type 2 diabetes: principles of pathogenesis and therapy.
Lancet, (2005), 365 pp. 1333-1346
[7.]
The Diabetes Control and Complications Trial Research Group.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.
N Engl J Med, (1993), 329 pp. 977-986
[8.]
UK Prospective Diabetes Study Group.
Intensive blood-glucose control with sulfonylurea or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet, (1998), 352 pp. 837-852
[9.]
UK Prospective Diabetes Study Group.
Effects of Intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34).
Lancet, (1998), 352 pp. 854-865
[10.]
Grupo para el Estudio de la Diabetes en Atención Primaria (Gedaps), Sociedad Española de Cardiología (SEC), Sociedad Española de Diabetes (SED), Sociedad Española de Medicina Interna (SEMI).
Documento 2005 de consenso entre varias sociedades cientificas sobre pautas de manejo del paciente diabético tipo 2 en España.
Av Diabetol, (2005), 21 pp. 20-33
[11.]
American Diabetes Association.
Standards of medical care in diabetes.
Diabetes Care, (2007), 30 pp. S4-S41
[12.]
Clinical Guidelines Task Force. Global guideline for type 2 diabetes. Brussels: International Diabetes Federation; 2005. Disponible en: http://www.idf.org.
[13.]
The American Association of Clinical Endocrinologists.
Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self—Management-2002.
Update Endocrine Pract, (2002), 8 pp. S40-S82
[14.]
Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary.
The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD).
Eur Heart J, (2007), 28 pp. 88-136
[15.]
P. Gaede, P. Vedel, N. Larsen, G. Jensen, H.H. Parving, O. Pendersen.
Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
N Engl J Med, (2003), 348 pp. 383-393
[16.]
D.M. Nathan.
Initial management of glycemia in type 2 diabetes mellitus.
N Engl J Med, (2002), 347 pp. 1342-1349
[17.]
M.A. Deeg.
Basic approach to managing hyperglycemia for the non endocrinologist.
Am J Cardiol, (2005), 96 pp. 37E-40E
[18.]
S.E. Izucchi.
Oral antihyperglycemic therapy for type 2 diabetes. scientific review.
JAMA, (2002), 287 pp. 360-372
[19.]
D.M. Nathan, J.B. Buse, M.B. Davidson, R.J. Heine, R.R. Holman, R. Sherwin, et al.
Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes.
Diabetes Care, (2006), 29 pp. 1963-1972
[20.]
D.M. Nathan, J.B. Buse, M.B. Davidson, R.J. Heine, R.R. Holman, R. Sherwin, et al.
Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes.
Diabetologia, (2006), 49 pp. 1711-1721
[21.]
D.M. Nathan.
Thiazolidinediones for initial treatment of type 2 diabetes?.
N Engl J Med, (2006), 355 pp. 2477-2480
[22.]
H. Yki-Jarvinen.
Thiazolidinediones.
N Engl J Med, (2004), 351 pp. 1106-1118
[23.]
S.E. Kahn, S.M. Haffner, M.A. Heise, W.H. Herman, R.R. Colman, N.P. Jones, et al.
Glycemic durability of rosiglitazone, metformine, or glyburide monotherapy.
N Engl J Med, (2006), 355 pp. 2427-2443
[24.]
DREAM (Diabetes Reduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators.
Effect of rosiglitazone on the frecuency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial.
Lancet, (2006), 368 pp. 1096-1105
[25.]
S.E. Nissen, K. Wolski.
Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes.
N Engl J Med, (2007), 356 pp. 2457-2471
[26.]
P.D. Home, D. Phil, S.T. Pocock, H. Beck-Nielsen, R. Gomis, M. Hanefeld, et al.
Rosiglitazone evaluated for cardiovascular outcomes: an interim analysis.
N Engl J Med, (2007), 357 pp. 1-11
[27.]
H. Yki-Jarvinen.
Combination therapies with insulin in type 2 diabetes.
Diabetes Care, (2001), 24 pp. 758-767
[28.]
A. Goudswaard, N.j. Furlong, G. Rutten, R. Stolk, G. Valk.
Insulin monotherapy versus combinations of insulin with oral hypoglycaemic agents in patients with type 2 diabetes mellitus.
Cochrane Database Syst Rev, (2004),
[29.]
U.K. Hirsch.
Insulin analogues.
N Engl J Med, (2005), 352 pp. 174-183
[30.]
G. Van der Berghe, P. Wounters, F. Weekers, C. Verwaest, F. Bruyninckx, M. Schetz, et al.
Intensive insulin therapy in the critically ill patients.
N Engl J Med, (2001), 345 pp. 1359-1367
[31.]
G. Van der Bergue.
How does blood glucose control with insulin save lives in intensive care?.
J Clin Invest, (2004), 114 pp. 1187-1195
[32.]
G.E. Unpierrez, S.D. Isaas, N. Bazargan, X. You, L.M. Thaler, A.E. Kitabchi.
Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.
J Clin Endocrinol Metab, (2002), 87 pp. 978-982
[33.]
A.P. Furnary, K.J. Zerr, G.L. Grunkemeier, A. Starr.
Continous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.
Ann Thorac Surg, (1999), 67 pp. 352-360
[34.]
K.J. Zerr, A.P. Furnary, G.L. Grunkemeier, S. Bookin, V. Kanhere, A. Atarr.
Glucose control lowers the risk of wound infection in diabetics after open heart operations.
Ann Thorac Surg, (1997), 63 pp. 356-361
[35.]
K. Malmberg, A. Norhammar, H. Weidel, L. Rydén.
Glycometabolic state at admission: important risk marker of mortality in Conventionally Treated Patients with Diabetes Mellitus and acute myocardial infarction. Long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study.
Circulation, (1999), 99 pp. 2626-2632
[36.]
K. Malmberg, L. Ryden, H. Wedel, K. Birkeland, A. Bootsma, K. Dickstein, et al.
Intensive metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidility.
Eur Heart J, (2005), 26 pp. 650-661
[37.]
A.J. Garber, E.S. Moghissi, E.D. Bransome, N.G. Clark, S. Clement, R.H. Cobin, et al.
American College of Endocrinology position statement on inpatient diabetes and metabolic control.
Endocr Pract, (2004), 10 pp. 77-82
[38.]
S.E. Inzucchi.
Management of hyperglycemia in the hospital setting.
N Engl J Med, (2006), 355 pp. 1903-1911
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