Características clínicas, epidemiológicas y metabólicas en diabéticos tipo 2 recién diagnosticados con insulina como terapéutica transitoria

Yohannys Cajigal Pelegrin, Odalys Arguelles Martínez, Maikel Roque Morgado, Eduardo Artiles Pardo

Texto completo:

HTML PDF

Resumen

Introducción: en los enfermos con diabetes mellitus tipo 2 el tratamiento inicial con insulina es una modalidad terapéutica utilizada.

Objetivo: caracterizar clínica, epidemiológica y metabólicamente los enfermos de diabetes mellitus tipo 2 con uso transitorio de insulina luego del diagnóstico.

Método: se realizó un estudio observacional descriptivo prospectivo en el Hospital General Provincial Docente de Ciego de Ávila durante el período de mayo 2015 a julio 2016. De una población de 131 enfermos de diabetes mellitus tipo 2 se tomó una muestra intencional de 67, a los cuales se les indicó insulina de forma transitoria luego del diagnóstico.

Resultados: la edad media fue 48,90 años. Predominaron las mujeres (56,71 %) y el antecedente familiar (94,02 %). La dosis media de insulina fue de 29,60 ± 6,20 Ud/día en 42,90 ± 9,3 días. Se produjo mejoría significativa entre el inicio y seis meses: índice de masa corporal (30,80 ± 2,3-28,60 ± 2,06); circunferencia de la cintura abdominal (hombres 108,3 ± 7,8-103,30 ± 6,20 cm y mujeres 103,60 ± 7,10-100,10 ± 5,70 cm); glucemia en ayunas (13,60 ± 1,30 mmol/L y PP2h: 22,10 ± 2,80-10 ± 0,70 mmol/L y 7,90 ± 1,10 mmol/L) y hemoglobina glucocilada (8,70 ± 1,10-6,90 ± 0,60 %). Las hipoglucemias fueron pocas: 2,90 % moderadas y 5,90 % ligeras. La casi totalidad se mantenía controlada con metformina a los seis meses (92,54 %).

Conclusiones: los resultados confirman que con el uso inicial transitorio de insulina se logra un control glucémico adecuado, mantenido posteriormente con monoterapia de metformina

Referencias

Referencias Bibliográfica

IDF. Diabetes Atlas. Sixth edition. 2014 [consultado 15 Sept 2016]. Disponible en: http://www.idf.org/atlasmap/atlasmap.

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015; 38(1):140-149

Pérez A, Mediavilla JJ, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. Rev Clin Esp. 2014;214:429-36.

Menendez Torre E, Lafita Tejedor FJ, Artola Menendez S, Millan Nunez-Cortes J, Alonso Garcia A, Puig Domingo M,et al. Recommendations for the pharmacological treatment of hyperglycemia in type 2 diabetes. Aten Primaria. 2011;43:202,e1-202.e9.

Standards of medical care in diabetes. Diabetes Care.2013;36 (1):11-66.

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. New Engl J Med. 1993;329:977-86.

Borgoño CA, Zinman B. Insulins: past, present and future. Endocrinol Metab Clin North Am. 2012;41(1):1-24.

Home P, Riddle M, Cefalu WT, Bailey CJ, Bretzel RG, del Prato S, et al. Insulin Therapy in people with type 2 diabetes: Opportunities and Challenges? Diabetes Care. 2014;37:1499-1508.

Tran L, Zielinski A, Roach AH, Jende JA, Householder AM, Cole EE, et al. Pharmacologic treatment of type 2 diabetes: injectable medications. Ann Pharmacother.2015;49:700–14.

Lee SJ. So much insulin, so much hypoglycemia. JAMA Intern Med. 2014;174:686-8. http://dx.doi.org/10.1001/jamainternmed.2013.13307.

Lipska KJ, Ross JS, Wang Y, Inzucchi SE, Minges K, Kar-ter AJ, et al. National trends in US hospital admissionsfor hyperglycemia and hypoglycemia among Medicare beneficiaries, 1999 to 2011. JAMA Intern Med. 2014;174:1116-4. http://dx.doi.org/10.1001/jamainternmed.2014.1824.

Seshasai SR, Kaptoge S, Thompson A,et al.; Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. N Engl.J Med 2011;364:829–841

Selvin E, Marinopoulos S, Berkenblit G, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 2004;141:421–431

Schmidt BM, Arora R. Primary prevention of cardiovascular complications in type II diabetes patients using aspirin: a complicated tale. Am J Ther 2013;20:275–278

González RM, Perich P, Arranz C. Trastornos metabólicos asociados con la evolución hacia la diabetes mellitus tipo 2 en una población en riesgo. Rev Cubana Endocrinol [revista en Internet]. 2010 [citado 12 sep 2016];21(2):[aprox.14p]. Disponible en: http://content.ebscohost.com/pdf25_26/pdf/2010/HBC/01May10/54855278.pdf

Montero-Monterroso J L, Gascón-Jiméneza JA, Vargas-Rubioa M D, Quero-Saladoa C, Villalba-Marína P, Pérula-de Torres L A. Prevalencia y factores asociados a la enfermedad arterial periférica en pacientes con diabetes mellitus tipo 2 en Atención Primaria. Semergen. 2015;41(4):183-190

Vella CH A, Burgos X, Ellis C J, Zubia R, Ontiveros D, Reyes H, Lozano C. Associations of Insulin ResistanceWith Cardiovascular Risk Factors and Inflammatory Cytokines in Normal Weight Hispanic Women. Diabetes Care. 2013;(36):1377- 1883

Gerstein HC, Bosch J, Dagenais GR, et al.;ORIGIN Trial Investigators. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012;367:319–32

Eng C, Kramer CK, Zinman B, Retnakaran R. Glucagon-like peptide-1 receptor agonist and basal insulin combination treatment for the management of type 2 diabetes: a systematic review and meta-analysis. Lancet. 2014;384(9961):2228-34.

Meier JJ, Bonadonna R C. Role of Reduced b-Cell Mass Versus Impaired b-Cell Function in the Pathogenesis of Type 2 Diabetes. Diabetes Care. 2013; (36): 2, 113-119.

DeVries JH. Intensive insulin therapy for type 2 diabetes at diagnosis. Lancet Diabetes Endocrinol 2013;1:3–4

Del Prado S,Bianchi C, Dardano A, Miccoli R. Insulin as an Early Treatment for Type 2 Diabetes. Diabetes Care. 2013;36(2): 198-204.

Edelman S, Pettus J. Challenges Associated with insulin therapy in type 2 diabetes mellitus. Am J Med. 2014;127(10):S11-6.

Campbell JE, Drucker DJ. Islet alpha cells and glucagon-critical regulators of energy homeostasis. Nat Rev Endocrinol. 2015;11(6):329-38.

Piñera MJ, Arrieta FJ, Alcaraz-Cebrián F, Botella-Carretero JI,Calañas A, Balsa JA, et al. Influencia de la pérdida de peso en la evolución clínica, metabólica y psicológica de los pacientes con sobrepeso u obesidad. NutrHosp. 2012;27:1480-8.

Svane MS, Madsbad S. Bariatric surgery-Effects on obesity and related co-morbidities. Curr Diabetes Rev. 2014;10:208-14.

McNeely MJ, Shofer JB, Leonetti DL, Fujimoto WY, Boyko EJ. Associations among visceral fat, all-cause mortality, and obesity-related mortality in Japanese Americans. Diabetes Care. 2012;35:296-8.

Lee YC, Lee WJ, Liew PL. Predictors of remission of type 2 diabetes mellitus in obese patients after gastrointestinal surgery. ObesResClinPract. 2013;7:e494---500.

Still CWG, Benotti P, Petrick AT, Gabrielsen J, Strodel WE, Ibele A, et al. Preoperative prediction of type 2 diabetes remission after Roux-en-Y gastric bypass surgery: A retrospective cohort study. Lancet DiabetesEndocrinol. 2014;2:3845

Kramer CK, Zinman B, Retnakaran R. Short term intensive insulin therapy and it impact on type 2 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2013;1:28–34

Pérez A, Franch J, Cases A, González Juanatey JR, Conthe P, Gimeno E, et al. Relación del grado de control glucémico con las características de la diabetes y el tratamiento de la hiperglucemia en la diabetes tipo 2. Estudio DIABES. MedClin. 2012;138:505-11.x

Kramer CK, Choi H, Zinman B, Retnakaran R. Determinants of reversibility of b-cel dysfunction in response to short-term intensive insulin therapy in patients with early type 2 diabetes. Am J PhysiolEndocrinolMetab 2013;305:E1398–E1407

Vinagre I, Sánchez-Hernández J, Sánchez-Quesada JL, María MA, de Leiva A, Pérez A. Switching to basal-bolus insulin therapy is effective and safe in long-term type 2 diabetes patients inadequately controlled with other insulin regimens. EndocrinolNutr. 2013;60:249-53.

Gerstein HC, Bosch J, Dagenais GR, et al.;ORIGIN Trial Investigators. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J Med 2012;367:319–328

UK Prospective Diabetes Study (UKPDS) Group. Intensive bloodglucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-53.

Tanaka S, Tanaka S, Iimuro S, Yamashita H, Katayama S, Akanuma Y, et al. Elderly Diabetes Predicting macro and microvascular complications in type 2 diabetes: The Japan Diabetes Complications Study/the Japanese Elderly Diabetes Intervention Trial risk engine. Diabetes Care. 2013;36:1193-9.

Cavalot F. Do data in the literature indicate that glycaemic variability is a clinical problem? Glycaemic variability and vascular complications of diabetes. Diabetes ObesMetab 2013;15(Suppl. 2): 3–8

DeVries JH. Glucose variability: where it is important and how to measure it. Diabetes 2013;62:1405–1408

Katon WJ, Young BA, Russo J, et al. Association of depression with increased risk of severe hypoglycemic episodes in patients with diabetes. Ann FamMed 2013; 11:245–250

Pérez A, Mediavilla JJ, Miñambres I, González-Segura D. Glycemic control in patients with type 2 diabetes mellitus in Spain. Rev Clin Esp. 2014;214:429-36.

Dehesa-López E, Manzanarez-Moreno I, Quintero Pérez A. Factores de riesgo asociados con episodios de hipoglucemia grave en pacientes diabéticos. MedIntMex. 2014;30:407-418.

Liu SC, Tu YK, Chien MN, ChienKL.Effect of antidiabetic agents added to metformin on glycaemic control, hypoglycaemia and weight change in patients with type 2 diabetes: a network metaanalysis. Diabetes ObesMetab 2012;14:810–820

Greibe E, Trolle B, Bor MV, Lauszus FF, Nexo E. Metformin lowers serum cobalamin without changing other markers of cobalamin status: a study on women with polycystic ovary syndrome. Nutrients 2013;5:2475–2482

Sorli C. New developments in insulin therapy for type 2 diabetes. Am J Med. 2014;127(10):39-48.

Simpson SH, Lee J, Choi S, Vandermeer B, Abdel moneim AS, Featherstone TR. Mortality risk among sulfonylureas: A systematic review and network metaanalysis. Lancet DiabetesEndocrinol. 2015;3:43-51.

Li Y, Hu Y, Ley SH, Rajpathak S, Hu FB. Sulfonylurea use and incident cardiovascular disease among patients with type 2 diabetes: Prospective cohort study among women. Diabetes Care. 2014;37:3106-13, http://dx.doi.org/10.2337/dc14-1306.

Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes,2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015; 38(1):140-149.



Copyright (c) 2021 Yohannys Cajigal Pelegrin, Odalys Arguelles Martínez, Maikel Roque Morgado, Eduardo Artiles Pardo

Licencia de Creative Commons
Esta obra está bajo una licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.