GEDAPS.Analysis DM 2

The REDGDPS publishes a critical analysis of the evidence available in type 2 diabetes

The Diabetes Study Group Network in Primary Health Care (REDGDPS) has published “Clinical Practice in DM2.Critical analysis of evidence by redgdps ”.The work, edited by Elsevier with the sponsorship of Ferrer, aimsSpecial emphasis on its application to primary care.

Among other recommendations, The guide bets on treatment with statin such as Simvastatin 40 mg or similar in primary prevention in patients with type 2 diabetes, regardless of cholesterol levels they present, if your cardiovascular risk is greater than 10% on the regicor scale .

As Dr. Patxi Ezkurra, coordinator of the work, points out, “the document tries to be a critical analysis of the available evidence on type 2 diabetes by the members of the GDPS network.This analysis tries to take advantage of the work done previously in other clinical practice guides through questions formulated in peak format (question, intervention, comparison and results) on different areas of type 2 diabetes ”.This update has been prepared previously assessing the evidence available in the Clinical Practice Guide on Type 2 Diabetes of the Ministry of Health, Social Policy and Equality and the Nice and Sign Guides (Scottish Intercollegiate Guidelines Network)

The issues addressed include diagnostic and screening phases, prevention, glycemic control, screening and treatment of cardiovascular risk factors, screening and treatment of microvascular complications (retinopathy and nephropathy), diabetic foot, health education and consultation organization.

glycosylated hemoglobin, new diagnostic test
The most relevant contents in the diagnosis area are related to the acceptance of glycosylated hemoglobin (HBA1C) as a new diagnostic and screening test in diabetes.In addition, the opportunistic screening on population screening for early detection and intervention on diabetes and associated cardiovascular risk factors is recommended.

“Currently, pharmacological treatments do not have advantages to prevent diabetes on the diet and exercise pattern in people at risk of diabetes.The diet of people with overweight type 2 diabetes must be hypocaloric, either by reducing caloric intake in general, the contribution of fats, the total contribution of carbohydrates - less than 50 grams/day - or increasing the proportion of hydratesCarbon with low glycemic index, limiting salt intake to less than 6 grams per day, ”says Dr. Ezkurra, family doctor and head of the Primary Care Unit at the Zumaia Health Center (Guipuzcoa).

Regarding the treatment of hyperglycemia, the book underlines the importance of individualization of therapeutic objectives.The very strict glycemic control objectives with approaches to glycemic normality in large recent studies have not demonstrated substantial benefits in cardiovascular morbidity and mortality, in patients with many years of evolution of diabetes and with cardiovascular affectation or high risk of suffering from it.

Patients with type 2 diabetes do not have a cardiovascular risk similar to that of those who have suffered a myocardial infarction and, therefore, they should not be systematically treated with statins or be anti -warned with aspirin before assessing their cardiovascular risk depending on validated tablesIn Spain.

“WaitingFrom last studies, we believe there is no evidence to deal with patients with DM 2, although those who have suffered a cardiovascular event, ”says Dr. Ezkurra.

Another relevant fact is that aggressively treat blood pressure to patients with type 2 diabetes to blood pressure figures smaller than 120 mm.HG has not presented cardiovascular benefits on objectives under 140 mm Hg and the evidence for diastolic tensions smaller than 80 mm Hg being very weak.

In the treatment for hypertension in patients with type 2 diabetes, thiazide diuretics at low doses are recommended and the angiotensin converting enzyme inhibitors (IECA), while, in those patients with nephropathy, IECA should be drugsof choice.If they are also hypertensive, treatment with full doses of them is recommended.

Recommendations for the prevention of diabetic retinopathy are based on the screening through the non -midriatic digital chamber with a periodicity of three years in patients with good controls and less than10 years of evolution of your diabetes.

In the treatment of hyperglycemia, metformin should be maintained with any insulin pattern.The different families of antidiabetic drugs have similar HBA1C decreases when added to metformin in the combined treatment of patients with type 2 diabetes. There are no notable differences between different families such as third drug added to metformin and sulfonylureas, except for inhibitors ofThe glycosidase alpha and glin, without significant differences to placebo.

In the field of insulins there are no significant differences between prolonged analogues (glargine, levemir) over the NPH and analog ultra -grade insulins on the regular human in patients with type 2 diabetes in terms of glycemic control.It highlights a clinically little significant difference in severe hypoglycemia in favor of prolonged insulin anologists with respect to NPH. NPH insulin and human regular in patients with type 2 diabetes are recommended as more cost-efficient therapy.

On the other hand, capillary blood glucose self -analysis should not be performed in patients with non -insulinized type 2 diabetes and stable metabolic control, except within supervised self -control programs and in motivated peopleor that they are starting a therapeutic change.
Importance of education
People with diabetes should be offered a structured education according to national standards at the time of diagnosis and continuously, with advanced programs according to their needs and allow changes in their lifestyle.“Programs must include concepts, practices and criteria to focus a particular type of problem, which serve as a reference to face and solve new problems of a similar nature.And they should encourage the self -control of the disease by promoting patient participation, ”says Dr. Ezkurra.

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The green that I have highlighted seems very important to me ...
Anticholsterol therapy indicates that not only glycemia lives the patient with diabetes ... cardiovascular prevention is immensely priority, although commonly forgotten by patients.

How blue I have highlighted I do not agree, it is more I consider it crazy.
The prevention of retinopathy is essential and its cost-benefit is enormous at all levels (economic, social, personal ...)
An annual eye background with a non -midriatic retinographer is the minimum to do.

NPH and regular insulin, force a Spartan food regime and usually ingest more calories than recommended.
It is incredible that with insulins such as Levemir, of such a little hypoglycemic profile and so easily manageable cornered it towards the background.

The absence of the recent incredine therapies is not surprising because its use, and knowledge is as little extended as the analysis of its results.
Despite this, in my opinion it would be the first option to consider in case of failure of metformin therapy+diet+exercise

Finally, self -analysis recommendations rightly affect diabetological education ... But of course, if it does not exist and we do not facilitate reactive strips, in the end what we have are demotivated patients and above all poorly controlled.

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