Información del artículo
Resumen
La insulina aspart aporta una serie de ventajas en su farmacocinética y farmacodinamia que la hacen una opción muy atractiva para su empleo en los pacientes de edad avanzada. La edad avanzada per se es uno de los factores que favorecen las hipoglucemias en el paciente insulinizado. Otros factores diferenciadores de la población anciana diabética insulinizada son: la polimedicación y el deterioro de la función renal y del nivel cognitivo.
Palabras clave:
Insulina
Aspart
Anciano
Diabetes
Análogo
Hipoglucemia
Variabilidad
Abstract
Insulin aspart offers some pharmacokinetic and pharmacodinamic advantages that make it a first option in elderly patients with diabetes. Advanced age per se is a risk factor for hypoglycemia. Other key issues in elderly patients with diabetes receiving insulin are concomitant polidrug therapies, progressive kidney damage and cognitive impairment.
Keywords:
Insulin
Aspart
Elderly
Diabetes
Analogue
Hypoglycaemia
Variability
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Bibliografía
[1.]
CDC, Center for Disease Control and Prevention. Percentage of Civilian, Noninstitutionalized Population with Diagnosed Diabetes by Age, United States, 1980–2009 [consultado 10-1-2012]. Disponible en: http://www.cdc.gov/diabetes/statistics/prev/national/figbyage.htm.
[2.]
F. Soriguer, A. Goday, A. Bosch-Comas, E. Bordiú, A. Calle-Pascual, R. Carmena, et al.
Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Di@abet.es Study.
Diabetologia, 55 (2012), pp. 88-93
[3.]
T. Hornick, D.C. Aron.
Managing diabetes in the elderly: go easy, individualize.
Cleve Clin J Med, 75 (2008), pp. 70-78
[4.]
A.G. Bertoni, J.S. Krop, G.F. Anderson, F.L. Brancati.
Diabetes-related morbidity and mortality in a national sample of U.S. elders.
Diabetes Care, 25 (2002), pp. 471-475
[5.]
D.C. Suh, C.M. Kim, I.S. Choi, C.A. Plauschinat.
Comorbid conditions and glycemic control in elderly patients with type 2 diabetes mellitus, 1988 to 1994 to 1999 to 2004.
J Am Geriatr Soc, 56 (2008), pp. 484-492
[6.]
J.A. Vázquez.
coordinador. La estrategia en diabetes del Sistema Nacional de Salud.
Ministerio de Sanidad y Consumo, (2007),
[7.]
R. Krones, C. Shütte, T. Heise.
The rapid-acting properties of insulin aspart are preserved in elderly people with type 2 diabetes.
Diabetes, Obesity and Metabolism, 11 (2009), pp. 41-44
[8.]
G.S. Meneilly.
A comparison of insulin aspart and regular insulin in elderly patients with type 2 diabetes.
Diabetes, Obesity and Metabolism, 9 (2007), pp. 754-755
[9.]
G. Tamás, M. Marre, R. Astorga, I. Dedov, J. Jacobsen, A. Lindholm.
Insulin Aspart Study Group Glycaemic control in type 1 diabetic patients using optimised insulin aspart or human insulin in a randomised multinational study.
Diabetes Research and Clinical Practice, 54 (2001), pp. 105-114
[10.]
I.B. Hirsh.
Insulin analogues.
New Eng J Med, 352 (2005), pp. 174-183
[11.]
P.D. Home, A. Lindholm, A. Riis.
For the European Insulin Aspart Study Group Insulin Aspart vs. human insulin in the management of long-term blood glucose control in Type 1 diabetes mellitus: a randomised controlled trial.
Diabet Med, 17 (2000), pp. 762-770
[12.]
P. Raskin, R.A. Guthrie, L. Leiter, A. Riis, L. Jovanovic.
Use of insulin aspart, a fast-acting insulin analog, as the meal-time insulin in the management of patients with type 1 diabetes.
Diabetes Care, 23 (2000), pp. 583-588
[13.]
L. Pala, E. Mannucci, I. Dicembrini, C.M. Rotella.
A comparison of mealtime insulin aspart and human insulin in combination with metformin in type 2 diabetes patients.
Diabetes Research and Clinical Practice, 78 (2007), pp. 132-135
[14.]
R.F. Pollock, W.J. Valentine, T. Pilgaard, H. Nishimura.
The cost effectiveness of rapid-acting insulin aspart compared with human insulin in type 2 diabetes patients: an analysis from the Japanese third-party payer perspective.
Journal of Medical Economics, 14 (2011), pp. 36-46
[15.]
A. Lloyd, C. Townsend, V. Munro, N. Twena, S. Nielsen, A. Holman.
Cost-effectiveness of insulin aspart compared to human insulin in pregnant women with type 1 diabetes in the UK.
Curr Med Res Opin, 25 (2009), pp. 599-605
[16.]
P.D. Home, L. Barriocanal, A. Lindholm.
Comparative pharmacokinetics and pharmacodynamics of the novel rapid-acting insulin analogue, insulin aspart, in healthy volunteers.
Eur J Clin Pharmacol, 55 (1999), pp. 199-203
[17.]
L.B. Haas.
Optimizing insulin use in type 2 diabetes: role of basal and prandial insulin in long-term care facilities.
J Am Med Dir Assoc, 8 (2007), pp. 502-510
[18.]
K. Turnheim.
When drug therapy gets old: pharmacokinetics and pharmacodynamics in the elderly.
Exp Gerontol, 38 (2003), pp. 843-853
[19.]
A.J. Sinclair.
Special considerations in older adults with diabetes: meeting the challenge.
Diabetes Spectrum, 19 (2006), pp. 229-233
[20.]
R. Oiknine, A.D. Mooradian.
Drug therapy of diabetes in the elderly.
Biomed Pharmacother, 57 (2003), pp. 231-239
[21.]
S.A. Amiel, T. Dixon, R. Mann, K. Jameson.
Hypoglycaemia in type 2 diabetes.
Diabetic Medicine, 25 (2008), pp. 245-254
[22.]
P.E. Cryer.
Mechanisms of sympathoadrenal failure and hypoglycemia in diabetes.
J Clin Invest, 116 (2006), pp. 1470-1473
[23.]
J.L. Leahy.
Insulin management of diabetic patients on general medical and surgical floors.
Endocr Pract, 12 (2006), pp. 86-90
[24.]
A. Chelliah, M.R. Burge.
Hypoglycaemia in elderly patients with diabetes mellitus: causes and strategies for prevention.
Drugs Aging, 21 (2004), pp. 511-530
[25.]
M. Brod, D. Cobden, M. Lammert, D. Bushnell, P. Raskin.
Examining correlates of treatment satisfaction for injectable insulin in type 2 diabetes: lessons learned from a clinical trial comparing biphasic and basal analogues.
Health and Quality of Life Outcomes, 5 (2007), pp. 8
[26.]
P. Murray, G.W. Chune, V.A. Raghavan.
Legacy effects from DCCT and UKPDS: what they mean and implication for future diabetes trials.
Curr Atheroscler Rep, 12 (2010), pp. 432-439
[27.]
The Diabetes Control and Complications Trial Research Group.
The absence of a glycaemic threshold for the development of long-term complications.
Diabetes, 45 (1996), pp. 1289-1298
[28.]
Action to Control Cardiovascular Risk in Diabetes Study Group, (ACCORD).
Effects of intensive glucose lowering in type 2 diabetes.
N Engl J Med, 358 (2008), pp. 2545-2559
[29.]
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
[30.]
VADT., Investigators.
Glucose control and vascular complications in veterans with type 2 diabetes.
N Engl J Med, 360 (2009), pp. 129-139
[31.]
D. Aguilar, B. Bozkurt, K. Ramasubbu, A. Deswal.
Relationship of hemoglobin A1c and mortality in heart failure patients with diabetes.
J Am Coll Cardiol, 54 (2009), pp. 422-428
[32.]
C.J. Currie, J.R. Peters, A. Tynan, M. Evans, R.J. Heine, O.L. Bracco, et al.
Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study.
Lancet, 375 (2010), pp. 481-489
[33.]
L. Landstedt-Hallin, A. Englund, U. Adamson, P.E. Lins.
Increased QT-dispersion during hypoglycaemia in patients with type 2 diabetes mellitus.
J Intern Med, 246 (1999), pp. 299-307
[34.]
K. Hermansen, P. Fontaine, K.K. Kukolja, V. Peterkova, G. Leth, M.A. Gall.
Insulin analogues (insulin detemir and insulin aspart) versus traditional human insulins (NPH insulin and regular human insulin) in basal.bolus therapy for patients with type 1 diabetes.
Diabetologia, 47 (2004), pp. 622-629
[35.]
P.D. Home, A. Lindholm, B. Hylleberg, P. Round.
Improved glycemic control with insulin aspart: a multicenter randomized double-blind crossover trial in type 1 diabetic patients. UK Insulin Aspart Study Group.
Diabetes Care, 21 (1998), pp. 1904-1909
[36.]
E.S. Huang.
Appropiate application of evidence to the care of elderly patients with diabetes.
Curr Diabetes Rev, 3 (2007), pp. 260-263
[37.]
G. Biesenbach, A. Raml, B. Schmekal, G. Eichbauer-Sturm.
Decreased insulin requirement in relation to GFR in nephropathic type 1 and insulin-treated Type 2 diabetic patients.
Diabet Med, 20 (2003), pp. 642-645
[38.]
G. Holmes, L. Galitz, P. Hu, W. Lyness.
Pharmacokinetics of insulin aspart in obesity, renal impairment, or hepatic impairment.
Br J Clin Pharmacol, 60 (2005), pp. 469-476
[39.]
G.A. Brunner, S. Hirschberger, G. Sendlhofer, A. Wutte, M. Ellmerer, B. Balent, et al.
Postprandial administration of the insulin analogue insulin aspart in patients with type 1 diabetes mellitus.
Diabetic Medicine, 17 (2000), pp. 371-375
[40.]
M.L. Warren, M.J. Conway, L.J. Klaff, J. Rosenstock, E. Allen.
Postprandial versus preprandial dosing of biphasic insulin aspart in elderly type 2 diabetes patients.
Diabetes Res Clin Pract, 66 (2004), pp. 23-29
[41.]
A.J. Garber, J. Wahlen, T. Wahl, P. Bressler, R. Braceras, E. Allen, et al.
Attainment of glycaemic goals in type 2 diabetes with once-, twice-, or thrice-daily dosing with biphasic insulin aspart 70/30 (The 1-2-3 study).
Diabetes, Obesity and Metabolism, 8 (2006), pp. 58-66
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