Control metabólico o reducción del riesgo vascular con los tratamientos actuales¿qué es prioritario?

  1. Margarita Alonso Fernández 1
  1. 1 Centro de Salud La Ería, Oviedo, España Universidad de Oviedo, Asturias, España
Revista:
Semergen: revista española de medicina de familia

ISSN: 1138-3593

Ano de publicación: 2018

Título do exemplar: Uso de inhibidores de la dipeptidil peptidasa 4 en pacientes con diabetes

Número: 1

Páxinas: 26-32

Tipo: Artigo

DOI: 10.1016/S1138-3593(18)30372-1 DIALNET GOOGLE SCHOLAR

Outras publicacións en: Semergen: revista española de medicina de familia

Objetivos de desarrollo sostenible

Resumo

In patients with type 2 diabetes, tight glycemic control prevents or delays the develop-ment of microvascular complications. In contrast, there is continued debate on the effect of macrovascular complications and the role of early glycaemic control on the ensuing cardiovascular disease. Although large randomised clinical trials have not shown a clearly beneficial effect of intensive control in the short term, subsequent follow-up studies of participants in these trials suggest a favourable cardiovascular effect in the long term. Due to doubts about the increased risk of myocardial infarction with rosiglitazone, for the last few years regulatory agencies have required sponsors to demonstrate the cardiovascular safety of new drugs before they can be approved for the treatment of hyperglycae-mia. The cardiovascular safety trials published to date have shown that the new drugs do not increase cardiovascular risk and that some molecules may even provide some cardiovascular protection. These findings raise the following question: what is the priority when selecting lipid-low-ering drugs – metabolic control or reduced cardiovascular risk? The answer lies in the word individualisation. Treatment cannot focus solely on cardiovascular safety, without considering microvascular complications, which cause high morbidity and mortality. Patients with recent onset diabetes and long life expectancy will benefit from tight meta-bolic control. Patients with diabetes and established cardiovascular disease or at high risk are candidates for treatment that includes drugs with a demonstrated benefit in this pa-tient group.

Referencias bibliográficas

  • S.S. Schwartz, S. Epstein, B.E. Corkey, S.F. Grant, J.R. Gavin 3rd, R.B. Aguilar The time is right for a new classifcation system for diabetes: rationale and implications of the b-cell-centric classifcation schema Diabetes Care, 39 (2016), pp. 179-186 CrossRefView Record in ScopusGoogle Scholar
  • R.A. Defronzo From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus Diabetes, 58 (2009), pp. 773-795 CrossRefView Record in ScopusGoogle Scholar
  • H. Gallagher, R.J. Suckling Diabetic nephropathy: where are we on the journey from pathophysiology to treatment? Diabetes Obes Metab, 18 (2016), pp. 641-647 CrossRefView Record in ScopusGoogle Scholar
  • A.J. Boulton, D.G. Armstrong, S.F. Albert, R.G. Frykberg, R. Hellman, M.S. Kirkman, et al. American Diabetes Association; American Association of Clinical Endocrinologists. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologist Diabetes Care, 31 (2008), pp. 1679-1685 CrossRefView Record in ScopusGoogle Scholar
  • B. Hemmingsen, S.S. Lund, C. Gluud, A. Vaag, T. Almdal, C. Hemmingsen, et al. Intensive glycaemic control for patients with type 2 diabetes: Systematic review with meta-analysis and trial sequential analysis of randomized clinical trials BMJ, 343 (2011), p. d6898 CrossRefGoogle Scholar
  • R. Hasan, B. Firwana, T. Elraiyah, J.P. Domecq, G. Prutsky, M. Nabhan, et al. A systematic review and meta-analysis of glycemic control for prevention of diabetic foot syndrome J Vasc Surg, 63 (2016), pp. 22S-28S Google Scholar
  • B.C. Callaghan, A.A. Little, E.L. Feldman, R. Hughes Enhanced glucose control for preventing and treating diabetic neuropathy Cochrane Database Syst Rev, 6 (2012), p. CD007543 View Record in ScopusGoogle Scholar
  • B. Hemmingsen, S.S. Lund, C. Gluud, A. Vaag, T. Almdal, C. Hemmingsen, et al. Targeting intensive glycaemic control versus targeting conventional glycaemic for type 2 diabetes mellitus Cochrane Database Syst Rev, 7 (2011), p. CD008143 View Record in ScopusGoogle Scholar
  • R. Boussageon, T. Bejan-Angoulvant, M. Saadatian-Elahi, S. Lafont, C. Bergeonneau, B. Kassaï, et al. Effect of intensive glucose lowering treatment on all-cause mortality, cardiovascular death, and microvascular events in type 2 diabetes: Meta-analysis of randomized controlled trials BMJ, 343 (2011), p. d4169 CrossRefView Record in ScopusGoogle Scholar
  • K.K. Ray, S.R. Seshasai, S. Wijesuriya, R. Sivakumaran, S. Nethercott, D. Preiss, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomized controlled trials Lancet, 373 (2009), pp. 1765-1772 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • T.N. Kelly, L.A. Bazzano, V.A. Fonseca, T.K. Thethi, K. Reynolds, J. He Systematic review: Glucose control and cardiovascular disease in type 2 diabetes Ann Intern Med, 151 (2009), pp. 394-403 CrossRefView Record in ScopusGoogle Scholar
  • B. Zinman, C. Warner, J.M. Lachin, D. Fitchett, E. Bluhmki, S. Hantel, et al. EMPAREG OUTCOME Investigators. Empaglifozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes N Engl J Med, 373 (2015), pp. 2117-2128 View Record in ScopusGoogle Scholar
  • B. Neal, V. Perkovic, K.V. Mahaffey, D. De Zeeuw, G. Fulcher, N. Erondu, et al. CANVAS Program Collaborative Group. Canaglifozin and Cardiovascular and Renal Events and Type 2 Diabetes N Engl J Med, 377 (2017), pp. 644-657 CrossRefView Record in ScopusGoogle Scholar
  • S.P. Marso, G.H. Daniels, K. Brown-Frandsen, P. Kristensen, J.F. Mann, M.A. Nauck, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes N Engl J Med, 375 (2016), pp. 311-322 CrossRefView Record in ScopusGoogle Scholar
  • M. Abdul-Ghani, R.A. DeFronzo Is it Time to Change the Type 2 Diabetes Treatment Paradigm? Yes! GLP-1 RAs Should Replace Metformin in the Type 2 Diabetes Algorithm Diabetes Care, 40 (2017), pp. 1121-1127 CrossRefView Record in ScopusGoogle Scholar
  • S.E. Inzucchi Is it Time to Change the Type 2 Diabetes Treatment Paradigm? No! Metformin Should Remain the Foundation Therapy for Type 2 Diabetes Diabetes Care, 40 (2017), pp. 1128-1132 CrossRefView Record in ScopusGoogle Scholar
  • R. Simo, C. Hernández Novel approaches for treating diabetic retinopathy based on recent pathogenic evidence Prog Retin Eye Res, 48 (2015), pp. 160-180 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • M. Alonso Fernández, F. Muñiz Fernández, M.T. de Alaiz Rojo Diabetes Mellitus: cuando las complicaciones preceden a la enfermedad Semergen, 43 (2017), pp. 530-532 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • R.R. Holman, S.K. Paul, M.A. Bethel, D.R. Matthews Neil HAW. 10-year follow-up of intensive glucose control in type 2 diabetes N Engl J Med, 359 (2008), pp. 1577-1589 CrossRefView Record in ScopusGoogle Scholar
  • I.M. Stratton, A.I. Adler, H.A. Neil, D.R. Matthews, S.E. Manley, C.A. Cull, et al. UK Prospective Diabetes Study Group. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study BMJ, 321 (2000), pp. 405-412 CrossRefView Record in ScopusGoogle Scholar
  • J.A. Beckman, M.A. Creager, P. Libby Diabetes and atherosclerosis: Epidemiology, pathophysiology, and management JAMA, 287 (2002), pp. 2570-2581 View Record in ScopusGoogle Scholar
  • K.E. Bornfeldt, I. Tabas Insulin resistance, hyperglycemia, and atherosclerosis Cell Metab, 14 (2011), pp. 575-585 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • A. Ceriello La “memoria metabólica” inducida por la hiperglucemia: el nuevo reto en la prevención de la enfermedad cardiovascular en la diabetes Rev Esp Cardiol Supl, 8C (2008), pp. 12-18 Google Scholar
  • F. Ismail-Beigi, T. Craven, M.A. Banerji, J. Basile, J. Calles, R.M. Cohen, et al. ACCORD trial group. Effect of intensive treatment of hyper-glycemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomized trial Lancet, 376 (2010), pp. 419-430 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • W. Duckworth, C. Abraira, T. Moritz, D. Reda, N. Emanuele, P.D. Reaven, et al. VADT Investigators. Glucose control and vascular complications in veterans with type 2 diabetes N Engl J Med, 360 (2009), pp. 129-139 CrossRefView Record in ScopusGoogle Scholar
  • R. Hayward, P. Reaven, W. Wiitala, G. Bahn, D. Reda, L. Ge, et al. VADT Investigators. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes N Engl J Med, 372 (2015), pp. 2197-2206 CrossRefView Record in ScopusGoogle Scholar
  • F.M. Turnbull, C. Abraira, R.J. Anderson, R.P. Byington, J.P. Chalmers, W.C. Duckworth, et al. Intensive glucose control and macrovas-cular outcomes in type 2 diabetes Diabetología, 52 (2009), pp. 2288-2298 Erratum in: Diabetología. 2009;52:2470 CrossRefView Record in ScopusGoogle Scholar
  • J.S. Skyler, R. Bergenstal, R.O. Bonow, J. Buse, P. Deedwania, E. Gale, et al. American Diabetes Association; American College of Cardiology Foundation; American Heart Association. Intensive glycemic control and the prevention of cardiovascular events: Implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a scientifc statement of the American College of Cardiology Foundation and the American Heart Association Diabetes Care, 32 (2009), pp. 187-192 CrossRefView Record in ScopusGoogle Scholar
  • J.A. Dormandy, B. Charbonnel, D.J. Eckland, E. Erdmann, M. Massi-Benedetti, I.K. Moules, et al. PROactive Investigations. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitazone Clinical Trial in macrovascular Events): a randomized controlled trial Lancet, 366 (2005), pp. 1279-1289 ArticleDownload PDFView Record in ScopusGoogle Scholar
  • E. Ferrannini, D.J. Betteridge, J.A. Dormandy, B. Charbonnel, R.G. Wilcox, R. Spanheimer, et al. High-density lipoprotein-cholesterol and not Hba1c was directly related to cardiovascular outcome in PROactive Diabetes Obes Metab, 13 (2011), pp. 759-764 CrossRefView Record in ScopusGoogle Scholar
  • S.R. Preis, M.J. Pencina, S.J. Hwang, R.B. D’Agostino, P.J. Savage, D. Levy, et al. Trends in cardiovascular disease risk factors in individuals with and without diabetes mellitus in the Framingham Heart Study Circulation, 120 (2009), pp. 212-220 View Record in ScopusGoogle Scholar
  • R.C. Turner, H. Millns, H.A. Neil Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom Prospective Diabetes Study (UKPDS: 23) BMJ, 316 (1998), pp. 823-828 CrossRefView Record in ScopusGoogle Scholar
  • P. Gaede, P. Vedel, N. Larsen, GVH. Jensen, H.H. Parving, O. Pedersen Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes N Engl J Med, 348 (2003), pp. 383-393 View Record in ScopusGoogle Scholar
  • P. Gaede, H. Lund-Andersen, H.H. Parvins, O. Pedersen Effect of a multifactorial intervention on mortality in type 2 diabetes N Engl J Med, 358 (2008), pp. 580-591 CrossRefView Record in ScopusGoogle Scholar
  • K. Ueki, T. Sasako, M. Kato, Y. Okazaki, S. Okahata, H. Katsuyama, et al. J-DOIT3 Study Group. Design of and rationale for the Japan Diabetes Optimal Integrated Treatment Study for 3 major risk factors of cardiovascular (J-DOIT3): a multicenter open-label, randomized, parallel-group trial BMJ Open Diabetes Res Care, 4 (2016), p. e000123 CrossRefView Record in ScopusGoogle Scholar
  • S.E. Nissen, K. Wolski Effect of rosiglitazone on the risk of myocardial infarctacion and death from cardiovascular causes N Engl J Med, 356 (2007), pp. 2457-2471 CrossRefView Record in ScopusGoogle Scholar
  • W.B. White, C.P. Cannon, S.R. Heller, S.E. Nissen, R.M. Bergenstal, G.L. Bakris, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes N Engl J Med, 369 (2013), pp. 1327-1335 CrossRefView Record in ScopusGoogle Scholar
  • B.M. Scirica, D.L. Bhatt, E. Braunwald, P.G. Steg, J. Davidson, B. Hirshberg, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus N Engl J Med, 369 (2013), pp. 1317-1326 CrossRefView Record in ScopusGoogle Scholar
  • J.B. Green, M.A. Bethel, P.W. Armstrong, J.B. Buse, S.S. Engel, J. Garg, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes N Engl J Med, 373 (2015), pp. 232-242 CrossRefView Record in ScopusGoogle Scholar
  • M.A. Pfeffer, B. Claggett, R. Diaz, K. Dickstein, H.C. Gerstein, L.V. Kober, et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome N Engl J Med, 373 (2015), pp. 2247-2257 View Record in ScopusGoogle Scholar