Palabras clave
análogos de GLP-1
diabetes mellitus tipo 2
incretinas
diabetes mellitus tipo 2
incretinas
Cómo citar
Polanía, E. J., Guzmán, G. E., Martínez Calvache, V., Fériz, K., García, C., Tabares, A., & Pardo, N. (2018). Manejo de diabetes mellitus tipo 2 con análogos GLP-1: una experiencia real. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 5(1), 22–27. https://doi.org/10.53853/encr.5.1.338
Resumen
Introducción: La diabetes mellitus tipo 2 (DM2) es un problema sanitario importante en la actualidad, con alta morbilidad, mortalidad, costos directos e indirectos. Nuevas estrategias de manejo se han implementado para disminuir su impacto. Este estudio describe la experiencia del manejo con análogos GLP-1.
Métodos: Estudio retrospectivo, descriptivo, de pacientes con diagnóstico de DM2 en manejo con análogos GLP-1. Se describieron características clínicas al inicio de la terapia y control entre 3 -y 6 meses.
Resultados: De 69 pacientes, 55,1% eran mujeres, con edad promedio 57,1 años. La mediana de duración de DM2 fue 13 años. Se encontró reducción significativa del peso 3 kg (p=0,00), HbA1c 1,7% (p=0), glucemia en ayunas 41 mg/dL (p=0), colesterol total 14 mg/dL (p=0,0069) y triglicéridos 38 mg/dL (p=0,0247). No se presentaron cambios significativos en la tensión arterial, colesterol HDL y LDL.
Conclusión: Los análogos GLP-1 en pacientes con DM2 generan mejoría significativa en control glucémico, peso y colesterol. Es necesario un seguimiento a largo plazo para determinar mantenimiento del control glucémico, pérdida de peso e impacto en el riesgo cardiovascular.
Citas
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15. Stephen C L Gough, Bruce Bode, Vincent Woo, Helena W Rodbard, Sultan Linjawi, Pernille Poulsen et al. Efficacy and safety of a fixed-ratio combination of insulin degludec and liraglutide (IDegLira) compared with its components given alone: results of a phase 3, open-label, randomised, 26-week, treat-to-target trial in insulin-naive patients with type 2 diabetes. Lancet Diabetes Endocrinol 2014 Nov;2(11):885-93
16. C. Mathieu, H. W. Rodbard, B. Cariou, Y. Handelsman, A. Philis-Tsimikas, A. M. Ocampo Francisco, et al. A comparison of adding liraglutide versus a single daily dose of insulin aspart to insulin degludec in subjects with type 2 diabetes (BEGIN: VICTOZA ADD-ON. Diabetes, Obesity and Metabolism 16: 636–644, 2014.
17. Marcus Lind, Irl B Hirsch, Jaakko Tuomilehto, Sofia Dahlqvist, Bo Ahrén, Ole Torffvit, et al. Liraglutide in people treated for type 2 diabetes with multiple daily insulin injections: randomised clinical trial (MDI Liraglutide trial). BMJ 2015;351: h5364.
18. García de Lucas M, Olalla J, Sempere M. Liraglutida reduce biomarcadores y riesgo vascular en pacientes con diabetes mellitus tipo 2. Rev Med Chil;141(12): 1602-1604, dic. 2013.
19. Davidson JA, Orsted DD, Campos C. Efficacy and safety of liraglutide, a once- daily human glucagon-like peptide-1 analogue, in Latino/Hispanic patients with type 2 diabetes: post hoc analysis of data from four phase III trials. Diabetes, Obesity and Metabolism 18: 725–728, 2016.
20. Buse, J, Drucker, D, Taylor K, Kim T, Walsh B, Hu H, et al. DURATION-1: ex- enatide once weekly produces sustained glycemic control and weight loss over 52 weeks. Diabetes Care. 2010; 33: 1255–1261.
21. Du Q1, Wang YJ, Yang S, Zhao YY, Han P. Liraglutide for the Treatment of Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Placebo-Controlled Trials. Adv Ther.2014. 31:1182–1195
22. Zachary t. Bloomgarden, Regina Dodis, Catherine m. Viscoli, Eric s. Holmboe, Silvio e. Inzucchi. Lower Baseline Glycemia Reduces Apparent Oral Agent Glucose-Lowering Efficacy. Diabetes care, volume 29, number 9, september 2006
23. Yu Mi Kang, Chang Hee Jung. Cardiovascular Effects of Glucagon-Like Peptide-1 Receptor Agonists. Endocrinol Metab 2016; 31:258-274
24. Russo G, Pintaudi B, Giorda C, Lucisano G, Nicolucci A, Cristofaro MR, et al. Age- and Gender-Related Differences in LDL-Cholesterol Management in Outpatients with Type 2 Diabetes Mellitus. Int J Endocrinol
2015;2015:957105.
2. UK Prospective Diabetes Study (UKPDS) Group. (1998). lntensive blood- glucose control with sulphonylureas or insulin compared with conventional treatment and risk of camplications in patients with type 2 diabetes (UKPDS 33). The Lancet, 1998; 352: 837-853.
3. ADVANCE Collaborative Group (2008). Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2008; (358), 2560- 2572.
4. William Duckworth, Carlos Abraira, Thomas Moritz, Domenic Reda, Nicholas Emanuele, Peter D. Reaven, et al. Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. N Engl J Med. 2009; 360:129-39.
5. Buse, J, Drucker, D, Taylor K, Kim T, Walsh B, Hu H, et al. DURATION-1: ex- enatide once weekly produces sustained glycemic control and weight loss over 52 weeks. Diabetes Care. 2010; 33: 1255–1261.
6. Buse J, Nauck M, Forst T, SheZ W, Shenouda S, Heilmann C. et al. Exenatide once weekly versus liraglutide once daily in patients with type 2 diabetes (DURATION-6). A randomized open-label study. Lancet, 2013; 381: 117– 124.
7. Steven P. Marso, Gilbert H. Daniels, Kirstine Brown-Frandsen, Peter Kristensen, Johannes F.E. Mann, Michael A. Nauck, y cols. For the LEADER Steering committee on behalf of the LEADER Trial Investigators. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016; 375:311- 22.
8. Pfeffer MA, Claggett B, Diaz R, Dickstein K, Gerstein HC, Køber LV, et al. for the ELIXA Investigators. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med, 2015; 373:2247-57.
9. Buse J, Rosenstock J, Sesti G, Schmidt W, Montanya E, Brett J. et al. Liraglutide once a day versus exenatide twice a day for type 2 diabetes: a 26-week randomised, parallel-group, multinational, open-label trial (LEAD-6). Lancet, 2009; 374: 39–47.
10. American Diabetes Association. (2016). Standards of medical care in diabetes- 2016. Diabetes care, 39 (Suppl 1), S13-S22.
11. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001; 414:782-787
12. Kumar PR, Bhansali A, Ravikiran M, et al. Utility of glycated hemoglobin in diagnosing type 2 diabetes mellitus: A community-based study. J Clin Endocrinol Metab 2010; 95:2832–2835
13. Análisis de Situación de Salud, COLOMBIA 2014. MINSALUD, Bogotá, D. C., Colombia, 2014, pp: 146-148.
14. Sten Madsbad. Review of head-to-head comparisons of glucagon-like peptide-1 receptor agonists. Diabetes, Obesity and Metabolism 18: 317–332, 2016.
15. Stephen C L Gough, Bruce Bode, Vincent Woo, Helena W Rodbard, Sultan Linjawi, Pernille Poulsen et al. Efficacy and safety of a fixed-ratio combination of insulin degludec and liraglutide (IDegLira) compared with its components given alone: results of a phase 3, open-label, randomised, 26-week, treat-to-target trial in insulin-naive patients with type 2 diabetes. Lancet Diabetes Endocrinol 2014 Nov;2(11):885-93
16. C. Mathieu, H. W. Rodbard, B. Cariou, Y. Handelsman, A. Philis-Tsimikas, A. M. Ocampo Francisco, et al. A comparison of adding liraglutide versus a single daily dose of insulin aspart to insulin degludec in subjects with type 2 diabetes (BEGIN: VICTOZA ADD-ON. Diabetes, Obesity and Metabolism 16: 636–644, 2014.
17. Marcus Lind, Irl B Hirsch, Jaakko Tuomilehto, Sofia Dahlqvist, Bo Ahrén, Ole Torffvit, et al. Liraglutide in people treated for type 2 diabetes with multiple daily insulin injections: randomised clinical trial (MDI Liraglutide trial). BMJ 2015;351: h5364.
18. García de Lucas M, Olalla J, Sempere M. Liraglutida reduce biomarcadores y riesgo vascular en pacientes con diabetes mellitus tipo 2. Rev Med Chil;141(12): 1602-1604, dic. 2013.
19. Davidson JA, Orsted DD, Campos C. Efficacy and safety of liraglutide, a once- daily human glucagon-like peptide-1 analogue, in Latino/Hispanic patients with type 2 diabetes: post hoc analysis of data from four phase III trials. Diabetes, Obesity and Metabolism 18: 725–728, 2016.
20. Buse, J, Drucker, D, Taylor K, Kim T, Walsh B, Hu H, et al. DURATION-1: ex- enatide once weekly produces sustained glycemic control and weight loss over 52 weeks. Diabetes Care. 2010; 33: 1255–1261.
21. Du Q1, Wang YJ, Yang S, Zhao YY, Han P. Liraglutide for the Treatment of Type 2 Diabetes Mellitus: A Meta-analysis of Randomized Placebo-Controlled Trials. Adv Ther.2014. 31:1182–1195
22. Zachary t. Bloomgarden, Regina Dodis, Catherine m. Viscoli, Eric s. Holmboe, Silvio e. Inzucchi. Lower Baseline Glycemia Reduces Apparent Oral Agent Glucose-Lowering Efficacy. Diabetes care, volume 29, number 9, september 2006
23. Yu Mi Kang, Chang Hee Jung. Cardiovascular Effects of Glucagon-Like Peptide-1 Receptor Agonists. Endocrinol Metab 2016; 31:258-274
24. Russo G, Pintaudi B, Giorda C, Lucisano G, Nicolucci A, Cristofaro MR, et al. Age- and Gender-Related Differences in LDL-Cholesterol Management in Outpatients with Type 2 Diabetes Mellitus. Int J Endocrinol
2015;2015:957105.
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