Importancia del control glucémico posprandial en el paciente con diabetes mellitus tipo 2
Resumen
La hiperglucemia postprandial es frecuente en personas con diabetes mellitus, incluso cuando el
control metabólico general parece adecuado, según los niveles de hemoglobina glucosilada.
Estudios han demostrado la relación entre los valores de glucemia postprandial y enfermedad
cardiovascular, independientemente de los valores de glucemia plasmática en ayunas. La diabetes
mellitus tipo 2 es una patología progresiva y las fluctuaciones postprandiales de la glucemia
parecen desempeñar un papel significativo en sus complicaciones vasculares. Las diferentes
Guías de Práctica Clínica hacen énfasis en la individualización de la propuesta terapéutica y
enfatizan la necesidad de sacar al paciente rápidamente del estado de hiperglucemia, combinando
precozmente cambios del estilo de vida con farmacoterapia, en una progresión rápida a doble y
triple terapia no insulínica o instalación temprana de insulinoterapia, combinada con otros
fármacos. Un enfoque racional basado en la fisiopatología de la enfermedad ha permitido un
notable desarrollo de la oferta fármaco-terapéutica. Es importante analizar las opciones de
intervención terapéutica sobre la hiperglucemia postprandial, dadas las experiencias negativas
relacionadas con la optimización del control y las dudas sobre la seguridad de los medicamentos.
Analizadas todas las alternativas para el control de la glucemia postprandial, en el momento actual
las intervenciones más eficaces serían los incretinomiméticos (GLP1ag y DPP-4I) con mayores
beneficios sobre la GPP, la HbA1c y el peso. El objetivo general para los pacientes con DMT2 es
una HbA1c ≤ 7%, con el fin de disminuir el riesgo de complicaciones, pero es razonable
individualizar el tratamiento, balanceando riesgos, beneficios y costos de la terapéutica planteada.
Palabras clave
Texto completo:
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