medigraphic.com
ISSN 0188-9796 (Print)

2010, Number 2

<< Back Next >>

Rev Endocrinol Nutr 2010; 18 (2)

Position statement of ALAD with endorsement of several Latin American Diabetes and Endocrinology Societies regarding the treatment of type 2 diabetes

Rosas-Guzmán J, Lyra R

Language: Spanish
References: 45
Page: 108-119
PDF size: 318.68 Kb.


ABSTRACT

The present consensus document, gathers the collaboration of over 20 National Societies of Diabetes and/or Endocrinology in order to give every Latin American physician a basic and practical guide of the management of type 2 diabetes mellitus. We consider a healthy lifestyle as the key element of the treatment at any time, describing in a precise way, the characteristics of a balanced diet, regular exercise and correcting of habits such as tobacco and alcohol use. The progressive nature of type 2 diabetes leads us to describe how to initiate and follow-up the pharmacological treatment in every patient, taking into account: weight, clinical shape and metabolic control. This is presented in a descriptive form within the text and summarized in an algorithm. Every treatment option available is analyzed and early insulinization is promoted in those patients who fail to achieve the treatment goals. An intensive treatment is advised for unstable patients and requires close monitoring and treatment with one of the insulin schemes already proven successful. Control goals should emphasize not only fasting and postprandial glycemia, and HbA1c; but also other parameters such as lipid profile, blood pressure, microalbuminuria, body mass index, etc. The due dates for achieving the therapeutic goals are within a range of 3 to 6 months. Conclusion: We present the update of a widely acknowledged document in Latin America which gives the practitioner a useful guide for the optimal treatment of the patient with type 2 diabetes mellitus.


REFERENCES

  1. Encuesta Nacional de Salud y Nutrición. ENSANUT 2006. http:/ /www.insp.mx/ensanut/

  2. Barceló A, Aedo C, Rajpathak S, Robles S. The Cost of Diabetes in Latin America and the Caribbean. WHO Bulletin 2003; 81: 19-27.

  3. Gouvea Ferreira SR. Epidemiología de las complicaciones de la diabetes mellitus. In: Rosas Guzmán J, Lyra R, Cavalcanti N, eds. Diabetes Mellitus, visión latinoamericana. Editora Guanabara Koogan SA. 43: 482-494.

  4. Simposium sobre economía y diabetes. ALAD, OPS and DOTA. www.paho.org/Spanish/AD/DPC/NC/dia-alad-background.pdf

  5. Arredondo A, Zuniga A. Economic consequences of epidemiological changes of diabetes in middle income countries. The Mexican case. Diabetes Care 2004; 27: 104-109.

  6. Guías ALAD de Diagnóstico, Control y Tratamiento de la Diabetes Mellitus tipo 2. Grupo de trabajo ALAD. Revista de la Asoc. Latinoamericana de Diabetes 2006; 16: 96-140.

  7. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28: 103-117.

  8. UK Prospective Diabetes Study (UKPDS) Group: Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complication in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853.

  9. UK Prospective Diabetes Study (UKPDS) Group: Effect of intensive blood glucose control with metformin on complication in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998; 352: 854-865.

  10. Nathan DM, Cleary PA, Backlund JY, on behalf of The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and complications (DCCT/EDIC) Study Research Group: Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med 2005; 353: 2643-2653.

  11. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. 10-Year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008; 359: 1577-1589.

  12. American Diabetes Association: Standards of medical care in diabetes-2009. Diabetes Care 2009; 29 (Suppl. 1): S13-S61.

  13. Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, Golden SH. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004; 141: 421-431.

  14. Stettler C, Allemann S, Juni P, Cull CA, Holman RR, Egger M, Krahenbuhl S, Diem P. Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: meta-analysis of randomized trials. Am Heart J 2006; 152: 27-38.

  15. Ray KK, Seshasai SR, Wijesuriya S, Sivakumaran R, Nethercott S, Preiss D, Erqou S, Sattar N. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomized controlled trials. Lancet 2009; 373: 1765-1772.

  16. Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB et al. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545-2559.

  17. Patel A, MacMahon S, Chalmers J, Neal B, Billot L, Woodward M, Marre M, Cooper M, Glasziou P, Grobbee D, Hamet P, Harrap S, Heller S, Liu L, Mancia G, Mogensen CE, Pan C, Poulter N, Rodgers A, Williams B, Bompoint S, de Galan BE, Joshi R, Travert F. ADVANCE Collaborative Group: Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008; 358: 2560-2572.

  18. Gerstein HC, Miller ME, Byington RP, Goff DC Jr, Bigger JT, Buse JB, Cushman WC, Genuth S, Ismail-Beigi F, Grimm RH Jr, Probstfield JL, Simons-Morton DG, Friedewald WT. Action to Control Cardiovascular Risk in Diabetes Study Group: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008; 358: 2545–2559.

  19. Johnson JA, Majumdar SR, Simpson SH et al. Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes. Diabetes Care 2002; 25: 2244.

  20. Johnson JA, Simpson SH, Toth EL, Majumdar SR. Reduced cardiovascular morbidity and mortality associated with metformin use in subjects with type 2 diabetes. Diabet Med 2005; 22: 497-502.

  21. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-41.

  22. National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002; 39(2 Suppl 1): S1-266.

  23. Bailey CJ, Turner RC. Metformin. N Engl J Med 1996; 334: 574-583.

  24. Nathan DM. Initial management of glycemia in type 2 diabetes mellitus. N Engl J Med 2002; 347: 1342-1349.

  25. Deeg MA. Basic approach to managing hyperglycemia for the nonendocrinologist. Am J Cardiol 2005; 96 (Suppl. 1): 37E-40E.

  26. Insuchi SE. Oral antihyperglycemic therapy for type 2 diabetes. JAMA 2002; 287: 360-372.

  27. Yki-Jarvinen H. Drug therapy: thiazolidinediones. N Engl J Med 2004; 351: 1106.

  28. Chiason JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOPNIDDM Trial. JAMA 2003; 290: 486-494.

  29. Palalau AI, Tahrani AA, Pilla MK, Barnett AH. DPPIV inhibitor in clinical practice. Postgrad Med 2009; 121: 70-100

  30. Kendall DM, Riddle MC, Rosenstock J, Zhuang D, Kim DD, Fineman MS, Baron AD. Effects of exenatide (exendin-4) on glycemic control and weight over 30 weeks in patients with type 2 diabetes treated with metfomin and a sulfonylurea. Diabetes Care 2005; 28: 1083-1091.

  31. DeFronzo R, Ratner RE, Han J, Kim DD, Fineman MS, Baron AD. Effects of exenatide on glycemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes. Diabetes Care 2005; 28: 1092-1100.

  32. Gerich J, Raskin P, Jean-Louis L, Purkayastha D, Baron A. PRESERVE-B: two year efficacy and safety of initial combination therapy with nateglinide or glyburide plus metformin. Diabetes Care 2005; 28: 2093-2100.

  33. Fonseca V, Rosentstock J, Patwardhan R, Salzman A. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus. JAMA 2000; 283: 1695-1702.

  34. Strowig S, Aviles-Santa ML, Raskin P. Improved glycemic control without weight gain using triple therapy in type 2 diabetes. Diabetes Care 2004; 27: 1577-1583.

  35. Bloomgarden ZT. Approaches to treatment of pre-diabetes and obesity and promising new approaches to type 2 diabetes. Diabetes Care 2008; 31: 1461-1466.

  36. Genuth S. Insulin use in NIDDM. Diabetes Care 1990; 13: 1240-1264.

  37. Raskin P, Allen E, Hollander P, Lewin A, Gabbay RA, Hu P, Bode B, Garber. Initiating insulin therapy in type 2 diabetes. Diabetes Care 2005; 28: 260-265.

  38. Yki-Jarvinen H, Ryysy L, Nikkila K, Tulokas T, Vanamo R, Heikkila M. Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus. Ann Intern Med 1999; 130: 389-396.

  39. Schwartz S, Sievers R, Strange P, Lyness WH, Hollander P. Insulin 70/30 mix plus metformin versus triple oral therapy in the treatment of type 2 diabetes after failure of two oral drugs. Diabetes Care 2003; 26: 2238-2243.

  40. Welschen LMC, Bloemendal E, Nijpels G, Dekker JM, Heine RJ, Stalman WAB, Bouter LM. Self monitoring of blood glucose in patients with type 2 diabetes who are not using insulin: a systematic review. Diabetes Care 2005; 28: 1510-1517.

  41. Stewart GL, Tambasia M, Rosas J et al. A Multi-Center, Epidemiologic Survey of the Current Medical Practice of General Practitioners Treating Subjects with type 2 Diabetes Mellitus In Latin America. DEAL STUDY. Diabetes 2007; 56 (suppl 1): A 256.

  42. Encuesta Nacional de Salud Pública en México. ENSA 2000. http://www.xipe.insp.mx/ensa/ensa_tomo2.pdf/

  43. AACE/ACE Diabetes Algorithm For Glycemic Control. http://www.aace.com/pub/

  44. Nathan DM, Buse JB, Davidson MB et al. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy; a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2009; 32: 193-203.

  45. Guías ALAD recomendadas por OPS. http://www.paho.org/spanish/ad/dpc/nc/dia-guia-alad.htm




2020     |     www.medigraphic.com