Tratamiento farmacológico del paciente que vive con diabetes mellitus tipo 2
DOI:
https://doi.org/10.21615/cesmedicina.6672Palabras clave:
Diabetes Mellitus Tipo 2, tratamiento farmacológico, enfermedades cardiovasculares, insuficiencia cardíaca, obesidad, insuficiencia renal crónicaResumen
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.
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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
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