Tratamiento farmacológico del paciente que vive con diabetes mellitus tipo 2

Autores/as

DOI:

https://doi.org/10.21615/cesmedicina.6672

Palabras clave:

Diabetes Mellitus Tipo 2, tratamiento farmacológico, enfermedades cardiovasculares, insuficiencia cardíaca, obesidad, insuficiencia renal crónica

Resumen

Introducción: el abordaje del paciente con diabetes mellitus tipo 2 ha cambiado a lo largo del tiempo. Años anteriores el enfoque terapéutico giraba en torno al nivel de hemoglobina glicada (HbA1c); ahora, con el advenimiento de nuevas moléculas, y luego de entender que la meta terapéutica no es sólo un punto de corte de HbA1c, se ha modificado el objetivo, para estar centrado en el paciente, en sus comorbilidades macro y microvasculares, riesgo cardiovascular y falla cardíaca. En esta revisión de la literatura se exponen las preguntas que se deben resolver al momento de definir una estrategia terapéutica en el paciente con diabetes mellitus tipo 2. Métodos: valoración de guías locales e internacionales de tratamiento de diabetes mellitus tipo 2. Resultados: se valoraron las guías del tratamiento de la diabetes mellitus tipo 2 realizadas por la Asociación Colombiana de Endocrinología, Asociación Colombiana de Medicina Interna, Asociación Colombiana de Nefrología, Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, American Diabetes Association, American Association of Clinical Endocrinology, European Association for the Study of Diabetes y European Society of Cardiology. Además, se revisaron los ensayos clínicos que respaldan el uso de los diferentes grupos farmacológicos disponibles para el tratamiento de los pacientes con diabetes mellitus tipo 2. Conclusión: es menester del clínico realizar el abordaje terapéutico de los pacientes con diabetes mellitus tipo 2 de forma individualizada, centrado en el riesgo cardiovascular, comorbilidades asociadas, riesgo de hipoglucemia y costos de la intervención brindada.

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Alex Ramírez Rincón, Universidad Pontificia Bolivariana

Médico Internista, Endocrinólogo. Clínica Integral de Diabetes. Profesor titular Universidad Pontificia Bolivariana, Colombia.

Santiago Saldarriaga Betancur, Universidad Pontificia Bolivariana

Médico, Residente de Medicina Interna. Universidad Pontificia Bolivariana, Colombia. 

Andrés Felipe García Ramos, Universidad Pontificia Bolivariana

Médico Internista, Fellow Endocrinología. Universidad Pontificia Bolivariana, Colombia. 

Juanita González Arango, Universidad Pontificia Bolivariana

Médico Internista, Fellow Endocrinología. Universidad Pontificia Bolivariana, Colombia.

Valentina Estupiñán Vargas, Universidad Pontificia Bolivariana

Médico Internista, Fellow Endocrinología. Universidad Pontificia Bolivariana, Colombia.

Referencias bibliográficas

IDF Diabetes Atlas 10th Edition 2021. [Internet]. Consultado el 16/03/2022. Disponible en: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas.html

Cuenta de alto costo. Colombia. [Internet]. Consultado el 15/12/2021. Disponible en: https://cuentadealtocosto.org/site/download/situacion-de-la-enfermedad-renal-cronica-la-hipertension-arterial-y-diabetes-mellitus-en-colombia-2019/

American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2022. Diabetes Care 2022 Jan; 45 (Supplement 1): S125-S143. Disponible en: https://diabetesjournals.org/care/article/45/Supplement_1/S125/138908/9-Pharmacologic-Approaches-to-Glycemic-Treatment

The Emerging Risk Factors Collaboration. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet 2010; 375: 2215–2222. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60484-9/fulltext

Newman JD, Schwartzbard AZ, Weintraub HS, Goldberg IJ, Berger JS. Primary Prevention of Cardiovascular Disease in Diabetes Mellitus. J Am Coll Cardiol. 2017 Aug 15;70 (7): 883-893. Disponible en: https://www.jacc.org/doi/abs/10.1016/j.jacc.2017.07.001

Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. European Heart Journal (2020) 41, 255-323. Disponible en: https://academic.oup.com/eurheartj/article/41/2/255/5556890?login=true

Castillo GA, Aroca G, Buelvas K, Buitrago AF, Carbllo V, Cárdenas JM, et al. Recomendaciones para el manejo del riesgo cardiorrenal en el paciente con diabetes mellitus tipo 2. Rev Colomb Cardiol. 2020;27 (S3): 3-22. Disponible en: https://www.elsevier.es/es-revista-revista-colombiana-cardiologia-203-articulo-recomendaciones-el-manejo-del-riesgo-S0120563320301078

Garber AJ, Handelsman Y, Grunberger G, Einhorn D, Abrahamson MJ, Barzilay JI, et al. CONSENSUS STATEMENT BY THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY ON THE COMPREHENSIVE TYPE 2 DIABETES MANAGEMENT ALGORITHM - 2020 EXECUTIVE SUMMARY. Endocr Pract. 2020 Jan;26 (1): 107-139. Disponible en: https://www.endocrinepractice.org/article/S1530-891X(20)35066-7/fulltext

Zelniker TA, Wiviott SD, Raz I, Im K, Goodrich EL, Bonaca MP, et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet. 2019 Jan 5;393 (10166): 31-39. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32590-X/fulltext

Neal B, Perkovic V, Mahaffey KW, Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med 2017; 377: 644-657. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1611925

Wiviott SD, Raz I, Bonaca MP, Mosenzon O, Kato ET, Cahn A, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2019; 380: 347-357. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa1812389

Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann J, Nauck M, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016; 375: 311–322. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1603827

Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016; 375: 1834-1844. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa1607141

Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2017; 377: 1228-1239. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1612917

Gerstein HC, Colhoun HM, Dagenais GR, Diaz R, Lakshmanan M, Pais P, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. Lancet 2019; 394: 121–30. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31149-3/fulltext

Husain M, Birkenfeld AL, Donsmark M, Dungan K, Eliaschewitz FG, Franco DR, et al. Oral Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2019; 381: 841-851. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa1901118

Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008 Feb 7; 358 (6): 580-91. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa0706245

UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854–865. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)07037-8/fulltext

Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117-2128. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1504720

Hernandez AF, Green JB, Janmohamed S, D’Agostino RB, Granger CB, Jones NP, et al. Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial. Lancet 2018; 392: 1519–29. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32261-X/fulltext

White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL, et al; EXAMINE Investigators. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013 Oct 3; 369 (14): 1327-35. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1305889

Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al; SAVOR-TIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013 Oct 3; 369 (14): 1317-26. Dispobible en: https://www.nejm.org/doi/full/10.1056/nejmoa1307684

Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, et al; TECOS Study Group. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2015 Jul 16; 373 (3): 232-42. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1501352

Rosenstock J, Perkovic V, Johansen OE, Cooper ME, Kahn SE, Marx N, et al; CARMELINA Investigators. Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk: The CARMELINA Randomized Clinical Trial. JAMA. 2019 Jan 1; 321 (1): 69-79. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2714646

Rosenstock J, Kahn SE, Johansen OE, Zinman B, Espeland MA, Woerle HJ, Pfarr E, Keller A, Mattheus M, Baanstra D, Meinicke T, George JT, von Eynatten M, McGuire DK, Marx N; CAROLINA Investigators. Effect of Linagliptin vs Glimepiride on Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes: The CAROLINA Randomized Clinical Trial. JAMA. 2019 Sep 24; 322 (12): 1155-1166. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2751398

Cannon CP, Pratley R, Dagogo-Jack S, Mancuso J, Huyck S, Masiukiewicz U, et al; VERTIS CV Investigators. Cardiovascular Outcomes with Ertugliflozin in Type 2 Diabetes. N Engl J Med. 2020 Oct 8; 383 (15): 1425-1435. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2004967

Pfeffer MA, Claggett B, Diaz R, Dickstein K, Gerstein HC, Køber LV, et al; ELIXA Investigators. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med. 2015 Dec 3; 373 (23): 2247-57. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1509225

Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al; EXSCEL Study Group. Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2017 Sep 28; 377 (13): 1228-1239. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1612917

Seferović PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, et al. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2018 May; 20 (5):853-872. Disponible en: https://onlinelibrary.wiley.com/doi/10.1002/ejhf.1170

McMurray JJV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, Martinez FA, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa1911303

Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med 2020; 383: 1413-1424. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2022190

Zhang XL, Zhu QQ, Chen YH, Li XL, Chen F, Huang JA, et al. Cardiovascular Safety, Long-Term Noncardiovascular Safety, and Efficacy of Sodium-Glucose Cotransporter 2 Inhibitors in Patients With Type 2 Diabetes Mellitus: A Systemic Review and Meta-Analysis With Trial Sequential Analysis. J Am Heart Assoc. 2018 Jan 20;7 (2): e007165. Disponible en: https://www.ahajournals.org/doi/10.1161/JAHA.117.007165?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Böhm M, et al. Empagliflozin in Heart Failure with a Preserved Ejection Fraction. N Engl J Med 2021; 385: 1451-61. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2107038

KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Disponible en: https://kdigo.org/wp-content/uploads/2022/03/KDIGO-2022-Diabetes-Management-GL_Public-Review-draft_1Mar2022.pdf

Wanner C, Inzucchi SE, Lachin JM, Fitchett D, von Eynatten M, Mattheus M, et al. Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. N Engl J Med. 2016 Jul 28; 375 (4): 323-34. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1515920

Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med. 2019 Jun 13; 380 (24): 2295-2306. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa1811744

Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou F-F, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8; 383 (15): 1436-1446. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2024816

Bhatt DL, Szarek M, Pitt B, Cannon CP, Leiter LA, McGuire DK, et al. Sotagliflozin in Patients with Diabetes and Chronic Kidney Disease. N Engl J Med. 2021 Jan 14; 384 (2): 129-139. Disponible en: https://www.nejm.org/doi/full/10.1056/nejmoa2030186

Kristensen SL, Rørth R, Jhund PS, Docherty KF, Sattar N, Preiss D, et al. Cardiovascular, mortality, and kidney outcomes with GLP-1 receptor agonists in patients with type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet Diabetes Endocrinol. 2019 Oct; 7 (10): 776-785. Disponible en: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30249-9/fulltext

Levey AS, de Jong PE, Coresh J, El Nahas M, Astor BC, Matsushita K, et al. The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney Int. 2011 Jul; 80 (1): 17-28.

Bakris GL, Agarwal R, Anker SD, Pitt B, Ruilope LM, Rossing P, et al. Effect of Finerenone on Chronic Kidney Disease Outcomes in Type 2 Diabetes. N Engl J Med. 2020 Dec 3; 383 (23): 2219-2229. Disponible en: https://www.kidney-international.org/article/S0085-2538(15)54924-7/fulltext

Pitt B, Filippatos G, Agarwal R, Anker SD, Bakris GL, Rossing P, et al. Cardiovascular Events with Finerenone in Kidney Disease and Type 2 Diabetes. N Engl J Med 2021; 385:2252-2263. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2110956

Garvey WT, Garber AJ, Mechanick JI, Bray GA, Dagogo-Jack S, Einhorn D, et al. American association of clinical endocrinologists and american college of endocrinology position statement on the 2014 advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. 2014 Sep; 20 (9): 977-89. Disponible en: https://www.endocrinepractice.org/article/S1530-891X(20)42241-4/fulltext

Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY EXECUTIVE SUMMARY. Endocr Pract. 2016 Jul; 22 (7): 842-84. Disponible en: https://www.endocrinepractice.org/article/S1530-891X(20)39214-4/fulltext

Pearson-Stuttard J, Bennett J, Cheng YJ, Vamos EP, Cross AJ, Ezzati M, et al. Trends in predominant causes of death in individuals with and without diabetes in England from 2001 to 2018: an epidemiological analysis of linked primary care records. Lancet Diabetes Endocrinol. 2021 Mar; 9 (3): 165-173. Disponible en: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30431-9/fulltext

Wilcox T, De Block C, Schwartzbard AZ, Newman JD. Diabetic Agents, From Metformin to SGLT2 Inhibitors and GLP1 Receptor Agonists: JACC Focus Seminar. J Am Coll Cardiol. 2020 Apr 28; 75 (16): 1956-1974. Disponible en: https://www.sciencedirect.com/science/article/pii/S0735109720344648?via%3Dihub

Lingvay I, Catarig AM, Frias JP, Kumar H, Lausvig NL, le Roux CW, et al. Efficacy and safety of once-weekly semaglutide versus daily canagliflozin as add-on to metformin in patients with type 2 diabetes (SUSTAIN 8): a double-blind, phase 3b, randomised controlled trial. Lancet Diabetes Endocrinol. 2019 Nov; 7 (11): 834-844. Disponible en: https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30311-0/fulltext

Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Vang Skjøth T, et al. Efficacy of Liraglutide for Weight Loss Among Patients With Type 2 Diabetes: The SCALE Diabetes Randomized Clinical Trial. JAMA. 2015 Aug 18; 314 (7): 687-99. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2428956

Davies M, Færch L, Jeppesen OK, Pakseresht A, Pedersen SD, Perreault L, et al. Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021 Mar 13; 397 (10278): 971-984. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00213-0/fulltext

Frías JP, Davies MJ, Rosenstock J, Pérez-Manghi FC, Fernández-Landó L, Bergman BK, et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med. 2021 Aug 5; 385 (6): 503-515. Disponible en: https://www.nejm.org/doi/full/10.1056/NEJMoa2107519

American Diabetes Association. 6. Glycemic Targets: Standards of Medical Care in Diabetes – 2022. Diabetes Care 2022 Jan; 45 (Supplement 1): S83-S96. Disponible en: https://diabetesjournals.org/care/article/45/Supplement_1/S83/138927/6-Glycemic-Targets-Standards-of-Medical-Care-in

Davies MJ, D’Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018; 41 (12): 2669–2701. Disponible en: https://diabetesjournals.org/care/article/41/12/2669/36544/Management-of-Hyperglycemia-in-Type-2-Diabetes

Bonnet F, Scheen A. Understanding and overcoming metformin gastrointestinal intolerance. Diabetes Obes Metab. 2017 Apr; 19 (4): 473-481. Disponible en: https://dom-pubs.onlinelibrary.wiley.com/doi/epdf/10.1111/dom.12854

Nathan DM, Buse JB, Kahn SE, Krause-Steinrauf H, Larkin ME, Staten M, et al.; GRADE Study Research Group. Rationale and design of the Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study (GRADE). Diabetes Care 2013; 36: 2254–2261. Disponible en: https://diabetesjournals.org/care/article/36/8/2254/32984/Rationale-and-Design-of-the-Glycemia-Reduction

Saldarriaga Betancur S. Enfoque terapéutico de la diabetes mellitus tipo 2 en adultos. Más allá de una meta glucémica. Medicina UPB 2018, 37 (1), 36-46. Disponible en: https://revistas.upb.edu.co/index.php/medicina/article/view/918

Wysham CH, Campos C, Kruger D. Safety and Efficacy of Insulin Degludec/Liraglutide (IDegLira) and Insulin Glargine U100/Lixisenatide (iGlarLixi), Two Novel Co-Formulations of a Basal Insulin and a Glucagon-Like Peptide-1 Receptor Agonist, in Patients With Diabetes Not Adequately Controlled on Oral Antidiabetic Medications. Clin Diabetes. 2018 Apr; 36 (2): 149-159.

Vedtofte L, Knop FK, Vilsboll T. Efficacy and safety of fixed‐ratio combination of insulin degludec and liraglutide (IDegLira) for the treatment of type 2 diabetes. Expert Opin Drug Saf. 2017; 16 (3): 387‐396. Disponible en: https://www.tandfonline.com/doi/abs/10.1080/14740338.2017.1288715?journalCode=ieds20

Aroda VR, Rosenstock J, Wysham C, Unger J, Bellido D, González-Gálvez G, et al; LixiLan-L Trial Investigators. Efficacy and Safety of LixiLan, a Titratable Fixed-Ratio Combination of Insulin Glargine Plus Lixisenatide in Type 2 Diabetes Inadequately Controlled on Basal Insulin and Metformin: The LixiLan-L Randomized Trial. Diabetes Care. 2016 Nov; 39 (11): 1972-1980. Disponible en: https://diabetesjournals.org/care/article/39/11/1972/37319/Efficacy-and-Safety-of-LixiLan-a-Titratable-Fixed

Descargas

Publicado

22-08-2022

Cómo citar

Ramírez Rincón, A., Saldarriaga Betancur, S., García Ramos, A. F., González Arango, J., & Estupiñán Vargas, V. (2022). Tratamiento farmacológico del paciente que vive con diabetes mellitus tipo 2. CES Medicina, 36(2), 81–105. https://doi.org/10.21615/cesmedicina.6672

Número

Sección

Revisión de tema

Artículos más leídos del mismo autor/a