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Vol. 58. Issue 3.
Pages 112-120 (March 2011)
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Vol. 58. Issue 3.
Pages 112-120 (March 2011)
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Recommendations for the pharmacological treatment of hyperglycemia in type 2 diabetes
Recomendaciones para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2
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Edelmiro Menéndez Torrea,
Corresponding author
, Francisco Javier Lafita Tejedora, Sara Artola Menéndeza, Jesús Millán Núñez-Cortésb, Ángeles Alonso Garcíac, Manuel Puig Domingod, José Ramón García Solanse, Fernando Álvarez Guisasolaf, Javier García Alegríag, Javier Mediavilla Bravoh, Carlos Miranda Fernández-Santosi, Ramón Romero Gonzálezj
a On behalf of the Working Group for Consensus and Clinical Guidelines of the Sociedad Española de Diabetes, Spain
b Sociedad Española de Arteriosclerosis (SEA), Spain
c Sociedad Española de Cardiología (SEC), Spain
d Sociedad Española de Endocrinología y Nutrición (SEEN), Spain
e Sociedad Española de Farmacia Comunitaria (SEFAC), Spain
f Sociedad Española de Medicina Familiar y Comunitaria (SEMFYC), Spain
g Sociedad Española de Medicina Interna (SEMI), Spain
h Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Spain
i Sociedad Española de Médicos Generales y de Familia (SEMG), Spain
j Sociedad Española de Nefrología (SEN), Spain
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References
[1.]
D.M. Nathan, J.B. Buse, M.B. Davidson, E. Ferrannini, R.R. Holman, R. Sherwin, 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, 32 (2009), pp. 193-203
[2.]
Canadian Diabetes Association 2008.
Clinical Practice Guidelines for the prevention and management of diabetes in Canada.
Can J Diabetes, 32 (2008), pp. S1-S201
[3.]
Algoritmo de tratamiento de la diabetes tipo 2. Guía de práctica clínica sobre diabetes tipo 2. Ministerio de Sanidad y Consumo, 2008. Available from: http://www9.euskadi.net/sanidad/osteba/datos/e_06_06_Diabetes_tipo_2.pdf.
[4.]
GEDAPS 2009. Algoritmo de tratamiento de la diabetes tipo 2. Available from: http://www. redgedaps.org/.
[5.]
National Collaborating Centre for Chronic Conditions. Type 2 diabetes: national clinical guideline for management in primary and secondary care (update). London: Royal College of Physicians; 2009. Available from: http://www.nice. org.uk/nicemedia/live/12165/44318/44318.pdf.
[6.]
AACE/ACE Consensus Statement.
Statement by an American Association of Clinical Endocrinologist/American College of Endocrinology Consensus Panel on type 2 diabetes mellitus: an algorithm for glycemic control.
Endocr Pract, 15 (2009), pp. 540-559
[7.]
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC).
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes.
N Engl J Med, 353 (2005), pp. 2643-2653
[8.]
R. Holman, S.K. Paul, M.A. Bethel, D.R. Matthews, H.A.W. Neil.
10-year follow-up of intensive glucose control in type 2 diabetes.
N Engl J Med, 359 (2008), pp. 1577-1589
[9.]
The ADVANCE collaborative group.
Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes.
N Engl J Med, 358 (2008), pp. 2560-2572
[10.]
W. Duckworth, C. Abraira, T. Moritz, D. Reda, N. Emanuele, P.D. Reaven, For the VADT Investigators, et al.
Glucose control and vascular complications in veterans with type 2 diabetes.
N Engl J Med, 360 (2009), pp. 129-139
[11.]
The Action to Control Cardiovascular Risk in Diabetes Study Group.
Effects of intensive glucose lowering in type 2 diabetes.
N Engl J Med, 358 (2008), pp. 2545-2559
[12.]
P. Gaede, H. Lund-Andersen, H.H. Parving, O. Pedersen.
Effect of a multifactorial intervention on mortality and in type 2 diabetes.
N Engl J Med, 358 (2008), pp. 580-591
[13.]
A.E. Kitabchi, G.E. Umpierrez, J.M. Miles, J.N. Fisher.
Hyperglycemic crises in adult patients with diabetes.
Diabetes Care, 32 (2009), pp. 1335-1343
[14.]
Look AHEAD Research Group.
Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial.
Diabetes Care, 30 (2007), pp. 1374-1383
[15.]
R. DeFronzo, A. Goodman.
Eficacy of metformin in patients with non-insulin-dependent diabetes mellitus. The Multicenter Metformin Study Group.
N Engl J Med, 333 (1995), pp. 541-549
[16.]
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, 352 (1998), pp. 854-865
[17.]
A.J. Krentz, R.E. Ferner, C.J. Bailey.
Comparative tolerability profiles of oral antidiabetic agents.
Drug Saf, 11 (1994), pp. 223-241
[18.]
A. Holstein, A. Plaschke, E.H. Egberts.
Lower incidence of severe hypoglycemia in patients with type 2 diabetes treated with glimepiride versus glibenclamide.
Diabetes Metab Res Rev, 17 (2001), pp. 467-473
[19.]
A.S. Gangji, T. Cukierman, H.C. Gerstein, C.H. Goldsmith, C.M. Clase.
A systematic review and meta-analysis of hipoglicemia and cardiovascular events: a comparison of glyburide with other secretagogues and with insulin.
Diabetes Care, 30 (2007), pp. 389-394
[20.]
A. Holstein, A. Plaschke, E.H. Egberts.
Lower incidence of severe hypoglycaemia in patients with type 2 diabetes treated with glimepiride versus glibenclamide.
Diabetes Metab Res Rev, 17 (2001), pp. 467-473
[21.]
S.E. Kahn, S.M. Haffner, M.A. Heise, W.H. Herman, R.R. Holman, N.P. Jones, ADOPT Study Group, et al.
Glycemic durability of rosiglitazone, metformin or glyburide monotherapy.
N Engl J Med, 355 (2006), pp. 2427-2443
[22.]
G. Belcher, C. Lambert, G. Edwards, R. Urquhart, D.R. Matthews.
Safety and tolerability of pioglitazone, metformin and gliclazide in the treatment of type 2 diabetes.
Diab Res Clin Pract, 70 (2005), pp. 53-62
[23.]
I.W. Campbell, D.G. Menzies, J. Chalmers, A.M. McBain, I.R. Brown.
One year comparative trial of metformin and glipizide in type 2 diabetes mellitus.
Diabet Metab, 20 (1994), pp. 394-400
[24.]
R. Scott, L. Wu, M. Sánchez, P. Stein.
Efficacy and tolerability of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy over 12 weeks in patients with type 2 diabetes.
Int J Clin Pract, 61 (2007), pp. 171-180
[25.]
P. Aschner, M.S. Kipnes, J.K. Lunceford, M. Sánchez, C. Mickel, D.E. Williams-Herman.
Effect of the dipeptidyl peptidase-4 inhibitor sitagliptin as monotherapy on glycemic control in patients with type 2 diabetes.
Diabetes Care, 29 (2006), pp. 2632-2637
[26.]
V. Mohan, W. Yang, H.Y. Son, L. Xu, L. Noble, R.B. Langdon, et al.
Efficacy and safety of sitagliptin in the treatment of patients with type 2 diabetes in China, India and Korea.
Diabetes Res Clin Pract, 83 (2009), pp. 106-116
[27.]
B. Göke, K. Hershon, D. Kerr, A. Calle Pascual, A. Schweizer, J. Foley, et al.
Efficacy and safety of vildagliptin monotherapy during 2-year treatment of drug-naïve patients with type 2 diabetes: comparison with Metformin.
Horm Metab Res, 40 (2008), pp. 892-895
[28.]
J. Rosenstock, C. Aguilar-Salinas, E. Klein, S. Nepal, J. List, R. Chen, CV181-011 Study Investigators.
Effect of saxagliptin monotherapy in treatment-naïve patients with type 2 diabetes.
Curr Med Res Opin, 25 (2009), pp. 2401-2411
[29.]
O.E. Johansen, K.I. Birkeland.
Defining the role of repaglinide in the management of type 2 diabetes mellitus: a review.
Am J Cardiovasc Drugs, 7 (2007), pp. 319-335
[30.]
J. Rosenstock, D.R. Hassman, R.D. Madder, S.A. Brazinsky, J. Farrell, N. Khutoryansky, et al.
Repaglinide versus nateglinide monotherapy: a randomized, multicenter study.
Diabetes Care, 27 (2004), pp. 1265-1270
[31.]
C. Black, P. Donnelly, L. McIntyre, P.L. Royle, J.P. Shepherd, S. Thomas.
Meglitinide analogues for type 2 diabetes mellitus.
Cochrane Database Syst Rev, 2 (2007), pp. CD004654
[32.]
J.F. Blicklé.
Meglitinide analogues: a review of clinical data focused on recent trials.
Diabetes Metab, 32 (2006), pp. 113-120
[33.]
J. Waugh, G.M. Keating, G.L. Plosker, S. Easthope, D.M. Robinson.
Pioglitazone: a review of its use in type 2 diabetes mellitus.
Drugs, 66 (2006), pp. 85-109
[34.]
P.D. Home, S.J. Pocock, H. Beck-Nielsen, P.S. Curtis, R. Gomis, M. Hanefeld, et al.
Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial.
Lancet, 373 (2009), pp. 2125-2135
[35.]
J.A. Dormandy, B. Charbonnel, D.J. Eckland, E. Erdmann, M. Massi-Benedetti, I.K. Moules, et al.
Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macro Vascular Events): a randomized controlled trial.
Lancet, 366 (2005), pp. 1279-1289
[36.]
D.J. Graham, R. Ouellet-Hellstrom, T.E. Macurdy, F. Ali, C. Sholley, C. Worrall, et al.
Risk of acute myocardial infarction, stroke, heart failure, death in elderly medicare patients treated with rosiglitazone or pioglitazone.
JAMA, 304 (2010), pp. 411-418
[37.]
H.E. Lebovitz, M.A. Banerji.
Insulin resistance and its treatment by thiazolidinediones.
Recent Prog Horm Res, 56 (2001), pp. 265-294
[38.]
R. Belfort, S.A. Harrison, K. Brown, et al.
A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis.
N Engl J Med, 355 (2006), pp. 2297-2307
[39.]
F.A. Van de Laar, P.L. Lucassen, R.P. Akkermans, E.H. Van de Lisdonk, W.J. De Grauw.
Alphaglucosidase inhibitors for type 2 diabetes mellitus.
Cochrane Database Syst Rev, 2 (2005), pp. CD003639
[40.]
J.L. Chiasson, R.G. Josse, R. Gomis, M. Hanefeld, A. Karasik, M. Laakso, STOP-NIDDM Trial Research Group.
Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial.
Lancet, 359 (2002), pp. 2072-2077
[41.]
E.A. Ryan, S. Imes, C. Wallace.
Short-term intensive insulin therapy in newly diagnosed type 2 diabetes.
Diabetes Care, 27 (2004), pp. 1028-1032
[42.]
Z.T. Bloomgarden.
Exploring treatment strategies for type 2 diabetes.
Diabetes Care, 30 (2007), pp. 2737-2745
[43.]
I. Lingvay, J.L. Legendre, P.F. Kaloyanova, S. Zhang, B. Adams-Huet, P. Raskin.
Insulin-based versus triple oral therapy for newly diagnosed type 2 diabetes: which is better?.
Diabetes Care, 32 (2009), pp. 1789-1795
[44.]
A.J. Garber, J. Larsen, S.H. Schneider, B.A. Piper, D. Henry.
Simultaneous glyburide/metformin therapy is superior to component monotherapy as an initial pharmacological treatment for type 2 diabetes.
Diabetes Obes Metab, 4 (2002), pp. 201-208
[45.]
L.S. Hermann, B. Scherstén, P.O. Bitzén, T. Kjellström, F. Lindgärde, A. Melander.
Therapeutic comparison of metformin and sulfonylurea, alone and in various combinations. A double-blind controlled study.
Diabetes Care, 17 (1994), pp. 1100-1109
[46.]
UK Prospective Diabetes Stud-54y (UKPDS) Group.
Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Lancet, 352 (1998), pp. 837-853
[47.]
J. Olsson, G. Lindberg, M. Gottsater, K. Lindwall, A. Sjostrand, A. Tisell, et al.
Increased mortality in type II diabetic patients using sulphonylurea and metformin in combination: a population based observational study.
Diabetologia, 43 (2000), pp. 558-560
[48.]
E. Mannucci, M. Monami, G. Masotti, N. Marchionni.
All-cause mortality in diabetic patients treated with combinations of sulfonylureas and biguanides.
Diabetes Metab Res Rev, 20 (2004), pp. 44-47
[49.]
E.Z. Fisman, A. Tenenbaum, V. Boyko, M. Benderly, Y. Adler, A. Friedensohn, et al.
Oral antidiabetic treatment in patients with coronary disease: time-related increased mortality on combined glyburide/metformin therapy over a 7. 7-year followup.
Clin Cardiol, 24 (2001), pp. 151-158
[50.]
K.H. Kahler, M. Rajan, G. Rhoads, M.M. Safford, K. Demissie, S.E. Lu.
Impact of oral antihyperglycemic therapy on all-cause mortality among patients with diabetes in the Veterans Health Administration.
Diabetes Care, 30 (2007), pp. 1689-1693
[51.]
J.A. Johnson, S.R. Majumdar, S.H. Simpson, E.L. Toth.
Decreased mortality associated with the use of metformin compared with sulfonylurea monotherapy in type 2 diabetes.
Diabetes Care, 25 (2002), pp. 2244-2248
[52.]
R. Moses, R. Slobodniuk, S. Boyages, S. Colagiuri, W. Kidson, J. Carter, et al.
Effect of repaglinide addition to metformin monotherapy on glycemic control in patients with type 2 diabetes.
Diabetes Care, 22 (1999), pp. 119-124
[53.]
P. Raskin, L. Klaff, J. McGill, S.A. South, P. Hollander, N. Khutoryansky, et al.
Efficacy and safety of combination therapy: repaglinide plus metformin versus nateglinide plus metformin.
Diabetes Care, 26 (2003), pp. 2063-2068
[54.]
P. Raskin.
Oral combination therapy: repaglinide plus metformin for treatment of type 2 diabetes.
Diabetes Obes Metab, 10 (2008), pp. 1167-1177
[55.]
B. Ahrén.
Clinical results of treating type 2 diabetic patients with sitagliptin, vildagliptin or saxagliptin -diabetes control and potential adverse events.
Best Pract Res Clin Endocrinol Metab, 23 (2009), pp. 487-498
[56.]
E. Bosi, R.P. Camisasca, C. Collober, E. Rochotte, A.J. Garber.
Effects of vildagliptin on glucose control over 24 weeks in patients with type 2 diabetes inadequately controlled with metformin.
Diabetes Care, 30 (2007), pp. 890-895
[57.]
M.A. Nauck, G. Meininger, D. Sheng, L. Terranella, P.P. Stein, Sitagliptin Study 024 Group.
Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, compared with the sulfonylurea, glipizide, in patients with type 2 diabetes inadequately controlled on metformin alone: a randomized, double-blind, non-inferiority trial.
Diabetes Obes Metab, 9 (2007), pp. 194-205
[58.]
E. Ferrannini, V. Fonseca, B. Zinman, D. Matthews, B. Ahrén, S. Byiers, et al.
Fifty-two-week ef.cacy and safety of vildagliptin vs. glimepiride in patients with type 2 diabetes mellitus inadequately controlled on metformin monotherapy.
Diabetes Obes Metab, 11 (2009), pp. 157-166
[59.]
R.A. DeFronzo, R.E. Ratner, J. Han, D.D. Kim, M.S. Fineman, A.D. Baron.
Effects of exenatide (exendin-4) on glycemic control and weight over 30 weeks in metformin-treated patients with type 2 diabetes.
Diabetes Care, 28 (2005), pp. 1092-1100
[60.]
M. Monami, N. Marchionni, E. Mannucci.
Glucagon-like peptide-1 receptor agonists in type 2 diabetes: a meta-analysis of randomized clinical trials.
Eur J Endocrinol, 160 (2009), pp. 909-917
[61.]
L.F. Van Gaal, S.W. Gutkin, M.A. Nauck.
Exploiting the antidiabetic properties of incretins to treat type 2 diabetes mellitus: glucagon-like peptide 1 receptor agonists or insulin for patients with inadequate glycemic control?.
Eur J Endocrinol, 158 (2008), pp. 773-784
[62.]
D.C. Klonoff, J.B. Buse, L.L. Nielsen, X. Guan, C.L. Bowlus, J.H. Holcombe, et al.
Exenatide effects on diabetes, obesity, cardiovascular risk factors and hepatic biomarkers in patients with type 2 diabetes treated for at least 3 years.
Curr Med Res Opin, 24 (2008), pp. 275-286
[63.]
B. Zinman, B.J. Hoogwerf, S. Durán García, D.R. Milton, J.M. Giaconia, D.D. Kim, et al.
The effect of adding exenatide to a thiazolidinedione in suboptimally controlled type 2 diabetes: a randomized trial.
Ann Int Med, 146 (2007), pp. 477-485
[64.]
E. Montanya, G. Sesti.
A review of ef.cacy and safety data regarding the use of liraglutide, a once-daily human glucagon-like peptide 1 analogue, in the treatment of type 2 diabetes mellitus.
Clin Ther, 31 (2009), pp. 2472-2488
[65.]
J. Rosenstock, J. Rood, A. Cobitz, C. Huang, A. Garber.
Improvement in glycaemic control with rosiglitazone/metformin .xed-dose combination therapy in patients with type 2 diabetes with very poor glycaemic control.
Diabetes Obes Metab, 8 (2006), pp. 643-649
[66.]
G. Bolli, F. Dotta, L. Colin, B. Minic, M. Goodman.
Comparison of vildagliptin and pioglitazone in patients with type 2 diabetes inadequately controlled with metformin.
Diabetes Obes Metab, 11 (2009), pp. 589-595
[67.]
R. Rajagopalan, S. Iyer, M. Khan.
Effect of pioglitazone on metabolic syndrome risk factors: results of double-blind, multicenter, randomized clinical trials.
Curr Med Res Opin, 21 (2005), pp. 163-172
[68.]
A. Ceriello, D. Johns, M. Widel, D.J. Eckland, K.J. Gilmore, M.H. Tan.
Comparison of effect of pioglitazone with metformin or sulfonylurea (monotherapy and combination therapy) on postload glycemia and composite insulin sensitivity index during an oral glucose tolerance test in patients with type 2 diabetes.
Diabetes Care, 28 (2005), pp. 266-272
[69.]
H. Yki-Jarvinen, L. Ryysy, K. Nikkila, T. Tulokas, R. Vanamo, M. Heikkila.
Comparison of bedtime insulin regimens in patients with type 2 diabetes mellitus.
Ann Int Med, 130 (1999), pp. 389-396
[70.]
M.C. Riddle, J. Rosenstock, J. Gerich, Insulin Glargine 4002 Study Investigators.
The treat-to-target trial: randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients.
Diabetes Care, 26 (2003), pp. 3080-3086
[71.]
S.G. Swinnen, M.P. Dain, R. Aronson, M. Davies, H.C. Gerstein, A.F. Pfeiffer, et al.
A 24-week, randomized, treat-to-target trial comparing initiation of insulin glargine once-daily with insulin detemir twice-daily in patients with type 2 diabetes inadequately controlled on oral glucose-lowering drugs.
Diabetes Care, 33 (2010), pp. 1176-1178
[72.]
J.L. Chiasson, L. Naditch, Miglitol Canadian University Investigator Group.
The synergistic effect of miglitol plus metformin combination therapy in the treatment of type 2 diabetes.
Diabetes Care, 24 (2001), pp. 989-994
[73.]
J.A. Kiayias, E.D. Vlachou, E. Theodosopoulou, E. Lakka-Papadodima.
Rosiglitazone in combination with glimepiride plus metformin in type 2 diabetic patients.
Diabetes Care, 25 (2002), pp. 1251-1252
[74.]
G.E. Dailey, M.A. Noor, J.S. Park, S. Bruce, F.T. Fiedorek.
Glycemic control with glyburide/metformin tablets in combination with rosiglitazone in patients with type 2 diabetes: a randomized, double-blind trial.
Am J Med, 116 (2004), pp. 223-229
[75.]
R. Roy, M. Navar, G. Palomeno, M.B. Davidson.
Real world effectiveness of rosiglitazone added to maximal (tolerated) doses of metformin and a sulfonylurea agent.
Diabetes Care, 27 (2004), pp. 1741-1742
[76.]
G. Charpentier, S. Halimi.
Earlier triple therapy with pioglitazone in patients with type 2 diabetes.
Diabetes Obes Metab, 11 (2009), pp. 844-854
[77.]
A.J. Scheen, M.H. Tan, D.J. Betteridge, K. Birkeland, O. Schmitz, B. Charbonnel, PROactive investigators.
Long-term glycaemic control with metformin-sulphonylurea-pioglitazone triple therapy in PROactive (PROactive 17).
Diabet Med, 26 (2009), pp. 1033-1039
[78.]
G. Papa, V. Fedele, M.R. Rizzo, M. Fioravanti, C. Leotta, S.B. Solerte, et al.
Safety of type 2 diabetes treatment with repaglinide compared with glibenclamide in elderly people: a randomized, open-label, two-period, cross-over trial.
Diabetes Care, 29 (2006), pp. 1918-1920
[79.]
K. Hermansen, M. Kipnes, E. Luo, D. Fanurik, H. Khatami, P. Stein.
Efficacy and safety of the dipeptidyl peptidase-4 inhibitor, sitagliptin, in patients with type 2 diabetes mellitus inadequately controlled on glimepiride alone or on glimepiride and metformin. Sitagliptin Study 035 Group.
Diabetes Obes Metab, 9 (2007), pp. 733-745
[80.]
M.T. Tran, M.D. Navar, M.B. Davidson.
Comparison of the glycemic effects of rosiglitazone and pioglitazone in triple oral therapy in type 2 diabetes.
Diabetes Care, 29 (2006), pp. 1395-1396
[81.]
R.R. Holman, A.J. Farmer, M.J. Davies, J.C. Levy, J.L. Darbyshire, J.F. Keenan, S.K. Paul, 4-T Study Group.
Three-year efficacy of complex insulin regimens in type 2 diabetes.
N Engl J Med, 361 (2009), pp. 1736-1747

See Annex at the end of the article.

In agreement with authors and editors, this article is published in whole in the following publications: Avances en Diabetología (Av Diabetol. 2010;26:331-8), Atención Primaria (Aten Primaria. 2011. doi:10.1016/j.aprim.2010.07.012), Semergen (Semergen. 2011.doi:10.1016/j.semerg.2010.11.002) and Clínica e Investigación en Arteriosclerosis (Clin Invest Arterioscl. 2011. doi: 10.1016/j. arteri.2011.01.007) and Revista Clínica Española (Rev Clin Esp. 2011. 10.1016/j.rce.2010.11.006).

Copyright © 2011. Sociedad Española de Endocrinología y Nutrición
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