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Vol. 26. Núm. 4.
Páginas 276-280 (Agosto - Agosto 2010)
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Vol. 26. Núm. 4.
Páginas 276-280 (Agosto - Agosto 2010)
Tema de actualidad
DOI: 10.1016/S1134-3230(10)64016-1
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Triple terapia en diabetes tipo 2: revisión sistemática de la evidencia disponible
Triple therapy in type 2 diabetes: systematic review of the available evidence
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C. Ortega Millán1,
Autor para correspondencia
comillan@gmail.com

Carlos Ortega Millán. Unidad de Gestión Clínica de Pozoblanco. c/ Laurel, s/n. 14400 Pozoblanco (Córdoba).
, J.A. Fornos Pérez2, R.V. García Mayor3, E. Menéndez Torre4
1 Médico de familia. Unidad de Gestión Clínica de Pozoblanco. Córdoba.
2 Doctor en Farmacia. Grupo Berbés de Investigación. Vigo.
3 Servicio de Endocrinología y Nutrición. Hospital Xeral-Cíes. Vigo.
4 Servicio de Endocrinología y Nutrición. HUCA. Oviedo
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Resumen
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Bibliografía
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Resumen

Las guías terapéuticas actuales difieren en las recomendaciones para la triple terapia cuando no se consiguen los objetivos con el tratamiento combinado de dos agentes orales. También difieren en el tipo de asociación y en la denominación de triple terapia. En el presente trabajo se realiza una revisión de la evidencia científica existente para determinar si la triple terapia es eficaz y segura, así como la asociación más favorable en el paciente con diabetes tipo 2. Revisando los estudios disponibles, se observa que la triple terapia mejora el control glucémico. Sin embargo, los ensayos clínicos aleatorizados disponibles en general no exceden el año de seguimiento, y no ofrecen datos sobre variables finales como morbilidad y mortalidad. En consecuencia, hasta el momento el beneficio a largo plazo y la seguridad de una triple terapia no están demostrados. En conclusión, con los datos disponibles actualmente no hay razón para retrasar la introducción de la insulina en el tratamiento de los pacientes con diabetes tipo 2 tras el fracaso de una terapia combinada doble, excepto en los casos de resistencia de los pacientes al inicio de la insulinización.

Palabras clave::
diabetes tipo 2
terapia triple
terapia combinada
tratamiento combinado
Keywords:
type 2 diabetes
triple therapy
combination therapy
Abstract

Current guidelines differ in their recommendations for triple therapy when targets are not achieved with a combined treatment of two oral agents. In addition, they diverge also in the type of association and the name given for the triple therapy. In the present manuscript we review the available scientific evidence to determine whether triple therapy is effective and safe, as well as the more favorable association in patients with type 2 diabetes. Reviewing available literature, we have noticed that triple therapy improves glycemic control. However, available randomized control trials do not extend more than one year of follow-up and they don't have data over endpoint variables as morbidity and mortality. Therefore, the long-term safety of triple therapy has not been demonstrated until now. In conclusion, with the currently available data there is no reason to delay introduction of insulin in the treatment of patients with type 2 diabetes after failure of dual combination therapy, except in cases of patients' resistance to initiate insulin therapy.

Lista de acrónimos citados en el texto:
AACE

American Association of Clinical Endocrinology

ACE

American College of Clinical Endocrinology

ADA

American Diabetes Association

ADO

antidiabético oral

APAIS-Health

Australian Public Affairs Information Service-Health

CINAHL

Cumulative Index to Nursing and Allied Health Literature

DM2

diabetes mellitus tipo 2

DPP-4

dipeptidilpeptidasa 4

EASD

European Association for the Study of Diabetes

EMBASE

Embase Biomedical Database

GEDAPS

Grupo de Estudio de la Diabetes en Atención Primaria de la Salud

GLN

glinidas

GLP-1

péptido similar al glucagón tipo 1

GLT

glitazonas

HbA1c

hemoglobina glucosilada

ICSI

Institute for Clinical Systems Improvement

MEDLINE

base de datos de la US National Library of Medicine

MET

metformina

NICE

National Institute for Clinical Excellence

SU

sulfonilureas

TT

triple terapia

TTI

triple terapia con insulina

TTO

triple terapia sin insulina

Texto completo
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