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Está ampliamente demostrado que el control glucémico previene la aparición de complicaciones microvasculares. En la actualidad, contamos con varios tipos de antidiabéticos orales (ADO) e insulinas para lograr este objetivo. Dada la evolución natural de la diabetes, lo habitual es que sea necesaria la asociación de varios fármacos para lograr los objetivos deseados en su control. Además, se ha demostrado que la asociación de fármacos que actúen por diferentes mecanismos da lugar a una mejoría en el control metabólico.
A este respecto, la guía EASD/ADA recomienda, tras el diagnóstico de diabetes mellitus tipo 2, comenzar el tratamiento con cambios en el estilo de vida y la administración de metformina. Si esto no logra un adecuado control glucémico, recomienda añadir un segundo ADO o insulina en un plazo de 2-3 meses. Y, en un tercer paso, si con esto tampoco se consiguen los objetivos deseados, se podría asociar insulina o intensificar el tratamiento con ésta. En el caso de una hemoglobina glucosilada<8% se puede plantear la asociación de 3 ADO.
Palabras clave:
Diabetes mellitus tipo 2
Control metabólico
Antidiabéticos orales
Insulina
Many studies have shown that glycemic control prevents microvascular complications in diabetic patients. Currently, there are several kinds of hypoglycemic agents and forms of insulin to achieve this goal. Given the progressive nature of type 2 diabetes, a combination of drugs is usually required. In addition, the association of drugs that act through different mechanisms improves glycemic control. The European Association for the Study of Diabetes/American Diabetes Association guidelines recommend that initial treatment consist of lifestyle modifications and metformin therapy. If the target objective is not achieved, a second hypoglycemic agent or insulin should be added within 2 or 3 months. If these measures are still insufficient, insulin should be added or treatment intensified. If HbA1c levels are below 8%, 3 oral hypoglycemic agents can be combined.
Key words:
Type 2 diabetes
Metabolic control
Oral hypoglycemic agents
Insulin
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