Guía para el tratamiento de la diabetes mellitus tipo 2 en el adulto
DOI:
https://doi.org/10.47196/diab.v59i1.1167Palabras clave:
guía, tratamiento, diabetes mellitus tipo 2, adultoResumen
Introducción: la diabetes mellitus (DM) es una de las condiciones crónicas más prevalentes en el mundo que afecta a 537 millones de personas; el 90% de los casos corresponde a diabetes mellitus tipo 2 (DM2), lo que representa un significativo desafío para los sistemas de salud.
Objetivos: a) actualizar la Guía de Tratamiento de la Diabetes Mellitus tipo 2 de la Sociedad Argentina de Diabetes (SAD) publicada en 2016; 2) proporcionar al equipo de salud una herramienta actualizada para optimizar el manejo terapéutico de las personas que viven con esta enfermedad, basada en la evidencia más reciente.
Materiales y métodos: se convocó a un grupo de expertos, miembros titulares de la SAD, para revisar la evidencia disponible y realizar una actualización de las recomendaciones para el tratamiento de la DM2. Se designó un responsable de redacción para la compilación final del documento.
Resultados: el manejo integral de la DM2 debe abordar no solo la alimentación y la actividad física, sino también aspectos claves del estilo de vida saludable como la cesación tabáquica, la abstención del consumo de alcohol, la higiene del sueño y la atención de la salud mental. Estos componentes constituyen la base de la terapéutica y deben considerarse en todas las etapas del tratamiento. La metformina sigue siendo un fármaco de primera línea, siempre que no existan contraindicaciones o intolerancia. En la selección del tratamiento farmacológico, es fundamental considerar la presencia de comorbilidades, especialmente la enfermedad cardiovascular. La presencia de enfermedad cardiovascular ateroesclerótica o de factores de alto riesgo cardiovascular debe orientar a la priorización temprana de agentes como los agonistas del receptor de GLP-1, los cuales demostraron reducir los eventos cardiovasculares. En personas con insuficiencia cardíaca o enfermedad renal crónica, los inhibidores de SGLT-2 se recomiendan porque su eficacia y seguridad en estos contextos están ampliamente respaldadas por la evidencia. Por otro lado, la presencia de obesidad debe orientar la elección de fármacos que no solo controlen la glucosa, sino que también favorezcan la pérdida de peso. Los agonistas del receptor de GLP-1 y los inhibidores de SGLT-2 tienen efectos beneficiosos en este aspecto. Es importante destacar que todas las clases de fármacos antidiabéticos, incluidos la insulina y sus análogos, pueden usarse como monoterapia o en combinación, respetando las contraindicaciones específicas y evitando el uso concomitante de fármacos con mecanismos de acción redundantes. El tratamiento debe ser reevaluado periódicamente cada 3-6 meses para evitar la inercia terapéutica y asegurar la optimización del control.
Conclusiones: los algoritmos propuestos sintetizan las recomendaciones actualizadas, y reflejan el avance en la evidencia científica, incorporando nuevas terapias y estrategias, orientando la toma de decisiones sobre el tratamiento de la DM2 con un enfoque integral.
Citas
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