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DIABETES MELLITUS

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Title: DIABETES MELLITUS Author: Hp Last modified by: Hp Created Date: 1/15/2013 10:52:44 PM Document presentation format: Presentaci n en pantalla (4:3) – PowerPoint PPT presentation

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Title: DIABETES MELLITUS


1
DIABETES MELLITUS
  • GdT de Enfermedades Cardiovasculares
  • SNaMFAP
  • Enero 2013

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Manejo de la hiperglucemia enfoque centrado en
el paciente
Nota Según la ADA el objetivo glucémico del
paciente con DM2 es HbA1c lt7,0 (lt53 mmol/mol)
Inzucchi et al. Diabetología 2012551577-96
  • DM2diabetes mellitus tipo 2

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Inzucchi et al. Diabetología 2012551577-96
  • DM2diabetes mellitus tipo 2 GIgastrointestinal
    ICinsuficiencia cardiaca
  • FOfractura ósea ADOs Antidiabéticos orales

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Inzucchi et al. Diabetología 2012551577-96
  • DM2diabetes mellitus tipo 2 GIgastrointestinal
    ICinsuficiencia cardiaca
  • FOfractura ósea ADOs Antidiabéticos orales

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Inzucchi et al. Diabetología 2012551577-96
  • DM2diabetes mellitus tipo 2 GIgastrointestinal
    ICinsuficiencia cardiaca
  • FOfractura ósea ADOs Antidiabéticos orales

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Inzucchi et al. Diabetología 2012551577-96
  • DM2diabetes mellitus tipo 2 GIgastrointestinal
    ICinsuficiencia cardiaca
  • FOfractura ósea ADOs Antidiabéticos orales

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Estrategias secuenciales de insulina en la
diabetes mellitus tipo 2
  • Inzucchi et al. Diabetología 2012551577-96

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Recomendaciones
Grado A Aspirina en prevención secundaria. El
tratamiento con aspirina a dosis bajas se debe
utilizar en todos los pacientes diagnosticados de
enfermedad coronaria o ictus o accidente
isquémico transitorio de forma indefinida.
Clopidogrel como alternativa a la aspirina. El
tratamiento con clopidogrel está indicado en
casos de alergia o intolerancia a la aspirina.
Doble antiagregación en el síndrome coronario
agudo. La doble antiagregación (aspirina y
clopidogrel) se debe utilizar después de un
síndrome coronario agudo sin elevación segmento
ST o revascularización coronaria e implantación
de stent durante un año.
Brotons Cuixart et al. Evidencias del tratamiento
antiagregante. Recomendaciones PAPPS. Aten
Primaria. 201244(12)734---736
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  • Grado C
  • Aspirina en prevención primaria. No se
    recomienda el uso de aspirina de forma
    sistemática en prevención primaria de la
    enfermedad cardiovascular, en diabéticos o en
    pacientes asintomáticos con un índice
    tobillo-brazo lt0,95. De forma individualizada y
    valorando la preferencia del paciente se podría
    valorar su utilización si el riesgo SCORE 10.
  • Grado D
  • Doble antiagregación en la enfermedad
    cardiovascular crónica y estable. La doble
    antiagregación no es más eficaz que la aspirina
    sola y no está indicada en los pacientes con
    enfermedad cardiovascular crónica y estable, ya
    sea coronaria o de otra localización.

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Executive Summary Standards of Medical Care in
Diabetes -2013
  • Antiplatelet agents
  • Consider aspirin therapy (75162 mg/day) as a
    primary prevention strategy in those with type 1
    or type 2 diabetes at increased cardiovascular
    risk (10-year risk gt10). This includes most men
    aged gt50 years or women aged gt60 years who have
    at least one additional major risk factor (family
    history of CVD, hypertension, smoking,
    dyslipidemia, or albuminuria). (C)
  • Aspirin should not be recommended for CVD
    prevention for adults with diabetes at low CVD
    risk (10-year CVD risklt5, such as in men agedlt50
    years and women aged lt60 years with no major
    additional CVD risk factors), since the potential
    adverse effects from bleeding likely offset the
    potential benefits. (C)
  • In patients in these age-groups with multiple
    other risk factors (e.g., 10-year risk 510),
    clinical judgment is required. (E)
  • Use aspirin therapy (75162 mg/day) as a
    secondary prevention strategy in those with
    diabetes with a history of CVD. (A)
  • For patients with CVD and documented aspirin
    allergy, clopidogrel (75mg/day) should be used.
    (B)
  • Combination therapy with aspirin (75162 mg/day)
    and clopidogrel (75mg/day) is reasonable for up
    to a year after an acute coronary syndrome. (B)

DIABETES CARE, VOLUME 36, SUPPLEMENT 1, JANUARY
2013
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Dyslipidemia/lipid management
  • Treatment recommendations and goals
  • Lifestyle modification focusing on the reduction
    of Dyslipidemia/lipid
  • Management fat, trans fat, and cholesterol
    intake increase of n-3 fatty acids, viscous
    fiber and plant stanols/sterols weight loss (if
    indicated) and increased physical activity
    should be recommended to improve the lipid
    profile in patients with diabetes. (A)
  • Statin therapy should be added to lifestyle
    therapy, regardless of baseline lipid levels, for
    diabetic patients
  • -with overt CVD (A)
  • -without CVD who are over the age of 40 years and
    have one or more other CVD risk factors (family
    history of CVD, hypertension, smoking,
    dyslipidemia, or albuminuria). (A)
  • For lower-risk patients than the above (e.g.,
    without overt CVD and under the age of 40 years),
    statin therapy should be considered in addition
    to lifestyle therapy if LDL cholesterol remains
    above 100 mg/dL or in those with multiple CVD
    risk factors. (C)
  • In individuals without overt CVD, the goal is LDL
    cholesterol lt100 mg/dL (2.6 mmol/L). (B)
  • In individuals with overt CVD, a lower LDL
    cholesterol goal of lt70 mg/dL (1.8 mmol/L), using
    a high dose of a statin, is an option. (B)
  • If drug-treated patients do not reach the above
    targets on maximal tolerated statin therapy, a
    reduction in LDL cholesterol of 3040 from
    baseline is an alternative therapeutic goal. (B)
  • Triglyceride levels lt150 mg/dL (1.7 mmol/L) and
    HDL cholesterol gt40 mg/dL (1.0 mmol/L) in men and
    gt50 mg/dL (1.3 mmol/L) in women are desirable
    (C). However, LDL cholesteroltargeted statin
    therapy remains the preferred strategy. (A)
  • Combination therapy has been shown not to provide
    additional cardiovascular benefit above statin
    therapy alone and is not generally recommended.
    (A)
  • Statin therapy is contraindicated in pregnancy.
    (B)

DIABETES CARE, VOLUME 36, SUPPLEMENT 1, JANUARY
2013
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