ACTUALIZACIÓN CLÍNICA/CONDUCTA A SEGUIR
Conducta terapéutica en la diabetes tipo 2. Cuanto más breve, mejor
Therapeutic behavior to follow in the following clinical case: Treatment of type 2 diabetes
L. Mateos, J. Herraez García, J.A. Martin Oterino, A. Sánchez Rodríguez
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Servicio de Medicina Interna I, Hospital Universitario de Salamanca, Salamanca, España
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"apellidos" => "Herraez García" ] 2 => array:2 [ "nombre" => "J.A." "apellidos" => "Martin Oterino" ] 3 => array:4 [ "nombre" => "A." "apellidos" => "Sánchez Rodríguez" "email" => array:1 [ 0 => "asanro@usal.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Medicina Interna I, Hospital Universitario de Salamanca, Salamanca, España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Therapeutic behavior to follow in the following clinical case: Treatment of type 2 diabetes" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2009-03-30" "fechaAceptado" => "2009-04-27" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec17967" "palabras" => array:3 [ 0 => "Hipertensión" 1 => "Diabetes" 2 => "Terapéutica" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec17968" "palabras" => array:3 [ 0 => "Hypertensión" 1 => "Diabetes" 2 => "Therapeutics" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Una mujer de 62 años con obesidad, hipertensión arterial y diabetes mellitus tipo 2 es remitida a una unidad de riesgo vascular del servicio de medicina interna porque su HbA<span class="elsevierStyleInf">1c</span> está elevada (8,1%) a pesar de tomar regularmente metformina (850<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) y glipizida (10<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h). Trata de hacer ejercicio cada día (caminar 30<span class="elsevierStyleHsp" style=""></span>min) y ha adelgazado (de 5 a 12<span class="elsevierStyleHsp" style=""></span>kg) en varias ocasiones, pero siempre ha vuelto a ganar lo perdido. Además se controla su glucemia en ayunas cada dos semanas y suele tener entre 120 y 160<span class="elsevierStyleHsp" style=""></span>mg/dl. Su hipertensión arterial está siendo tratada con enalapril/hidroclorotiazida y además toma aspirina (100<span class="elsevierStyleHsp" style=""></span>mg/día) y simvastatina (20<span class="elsevierStyleHsp" style=""></span>mg/día). En su historia familiar se recoge que un hermano falleció súbitamente a los 50 años. En la exploración física presenta un IMC de 32,4<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span> y no tiene edemas en los miembros inferiores. Su PA es de 154/82<span class="elsevierStyleHsp" style=""></span>mmHg y la creatinina de 0,9<span class="elsevierStyleHsp" style=""></span>mg/dl. No presenta microalbuminuria y su función hepática es normal.</p><p class="elsevierStyleSimplePara elsevierViewall">¿Qué tratamiento le parece a Vd. más indicado?</p><p class="elsevierStyleSimplePara elsevierViewall">1. Añadir glitazonas.</p><p class="elsevierStyleSimplePara elsevierViewall">2. Añadir incretín miméticos (glucagon like peptide 1 [GLP1]/inhibidores de la dipeptidilpeptidasa 4 [DPP-4]).</p><p class="elsevierStyleSimplePara elsevierViewall">3. Añadir insulina de acción lenta.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">A 62-year old woman with obesity, high blood pressure and type 2 diabetes mellitus (DM2) was referred to a Vascular Risk Unit of the Internal Medicine Department due to elevated HbA1C (8.1%) in spite of having taken metformin (850<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) and glipizide (10<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) regularly. She tries to exercise daily (walking 30<span class="elsevierStyleHsp" style=""></span>min) and has lost weight (from 5 to 12<span class="elsevierStyleHsp" style=""></span>kg) several times, but always regains what she has lost. Furthermore, she monitors her glucose levels in fasting every two weeks and generally has between 120 and 160<span class="elsevierStyleHsp" style=""></span>mg/dL. Her high blood pressure is being treated with enalapril/HCTZ and she also takes aspirin 100<span class="elsevierStyleHsp" style=""></span>mg/day and simvastatin 20<span class="elsevierStyleHsp" style=""></span>mg/day. It is seen in her family background that one brother died suddenly at 50 years of age. Her physical examination shows a BMI of 32.4<span class="elsevierStyleHsp" style=""></span>Kg/m<span class="elsevierStyleSup">2</span>, and she has no edemas in the lower limbs. Her BP is 154/82<span class="elsevierStyleHsp" style=""></span>mmHg and creatinine 0.9<span class="elsevierStyleHsp" style=""></span>mg/dL. She has no microalbuminuria and her liver function is normal.</p><p class="elsevierStyleSimplePara elsevierViewall">What treatment do you think would be the more appropriate?</p><p class="elsevierStyleSimplePara elsevierViewall">1 - Add glitazones.</p><p class="elsevierStyleSimplePara elsevierViewall">2 - Add incretin mimetics (GLP 1/ DPP-4).</p><p class="elsevierStyleSimplePara elsevierViewall">3 - Slow acting insulin.</p>" ] ] ] "idiomaDefecto" => "es" "url" => "/00142565/0000021000000001/v3_201302081013/S0014256509000228/v3_201302081013/es/main.assets" "Apartado" => array:4 [ "identificador" => "995" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Actualización clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/00142565/0000021000000001/v3_201302081013/S0014256509000228/v3_201302081013/es/main.pdf?idApp=WRCEE&text.app=https://www.revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256509000228?idApp=WRCEE" ]
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