{"id":884,"date":"2021-09-07T08:06:41","date_gmt":"2021-09-07T08:06:41","guid":{"rendered":"https:\/\/primastcar.com\/?p=884"},"modified":"2022-02-23T08:28:49","modified_gmt":"2022-02-23T08:28:49","slug":"decalogo-de-recomendaciones-basicas-en-diabetes-resumen-de-las-guias-europea-y-americana-de-practica-clinica","status":"publish","type":"post","link":"https:\/\/primastcar.com\/?p=884","title":{"rendered":"DEC\u00c1LOGO DE RECOMENDACIONES B\u00c1SICAS EN DIABETES: RESUMEN DE LAS GU\u00cdAS EUROPEA Y AMERICANA DE PR\u00c1CTICA CL\u00cdNICA"},"content":{"rendered":"<p><\/p>\n\n\n<h4><strong>AUTORES:&nbsp;<\/strong>Dr. Jes\u00fas Mar\u00eda de la Hera. Cardi\u00f3logo en HUCA y Centro M\u00e9dico de Asturias. Expresidente de la SAC. y Dr. Rub\u00e9n Villa. M\u00e9dico de Familia en CS Grado. Presidente de SAMFYC.<\/h4>\n\n\n\n<h3 class=\"has-vivid-red-color has-text-color\">Riesgo Cardiovascular:<\/h3>\n\n\n<h5 id=\"block-5b43bd39-f620-49ed-a448-4670341c08cb\" class=\"block-editor-rich-text__editable block-editor-block-list__block wp-block is-selected rich-text\" tabindex=\"0\" role=\"group\" contenteditable=\"true\" aria-multiline=\"true\" aria-label=\"Bloque: Encabezado\" data-block=\"5b43bd39-f620-49ed-a448-4670341c08cb\" data-type=\"core\/heading\" data-title=\"Encabezado\">1. La estratificaci\u00f3n del riesgo cardiovascular (RCV) es b\u00e1sica en el manejo del paciente diab\u00e9tico. Existen<br data-rich-text-line-break=\"true\">pacientes de moderado, alto y muy alto riesgo cardiovascular<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"1024\" height=\"154\" src=\"https:\/\/primastcar.com\/wp-content\/uploads\/2021\/09\/decalogo1-1024x154.png\" alt=\"\" class=\"wp-image-885\"\/><\/figure>\n\n\n<h5>2. En general, las t\u00e9cnicas de imagen no aportan valor a\u00f1adido en la estratificaci\u00f3n del RCV del paciente <br>diab\u00e9tico y \u00e9sta puede realizarse con variables cl\u00ednicas. La aspirina no est\u00e1 recomendada para la <br>prevenci\u00f3n primaria de la enfermedad cardiovascular en diab\u00e9ticos, salvo en pacientes de muy alto RCV <br>una vez evaluado el riesgo hemorr\u00e1gico. En prevenci\u00f3n secundaria se recomienda aspirina 100 mg\/dia en <br>monoterapia.<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<h3 class=\"has-vivid-red-color has-text-color\">Objetivos en el control gluc\u00e9mico:<\/h3>\n\n\n<h5>3. Debe ser individualizado. Se mantiene un valor de HbA1c &lt; 7% para la mayor\u00eda de los pacientes. Se <br>acepta un control m\u00e1s relajado HbA1c &lt; 8-8,5% en pacientes fr\u00e1giles y se debe buscar un control m\u00e1s <br>estricto, HbA1c &lt; 6,5% en pacientes sin comorbilidades y buena expectativa de vida si puede alcanzarse sin <br>hipoglucemias significativas<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<h3 class=\"has-vivid-red-color has-text-color\">Elecci\u00f3n del f\u00e1rmaco hipoglucemiante:<\/h3>\n\n\n<h5>4. Es el RCV el que determina en primera instancia la elecci\u00f3n del f\u00e1rmaco hipoglucemiante y si \u00e9ste es <br>alto o muy alto debe incorporarse en su arsenal terap\u00e9utico un inhibidor SGLT2 (iSGLT2) y\/o un agonista del <br>receptor GLP1 (arGLP1).<\/h5>\n<h5>5. La metformina es el f\u00e1rmaco de primera elecci\u00f3n para la mayor\u00eda de las gu\u00edas y consensos, cuando el <br>filtrado glomerular es superior a 30 ml\/min. La prescripci\u00f3n de metformina no debe impedir la asociaci\u00f3n <br>de iSGLT2 y\/o arGLP1 en pacientes de alto\/muy alto RCV.&nbsp;<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"1024\" height=\"102\" src=\"https:\/\/primastcar.com\/wp-content\/uploads\/2021\/09\/decalogo2-1024x102.png\" alt=\"\" class=\"wp-image-886\"\/><\/figure>\n\n\n<h5>6. En pacientes de alto\/muy alto RCV, iSGLT2 ser\u00e1 prioritario cuando predomine insuficiencia card\u00edaca o <br>renal y arGLP1 cuando predomine enfermedad coronaria o cerebrovascular asociada a obesidad.<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<h3 class=\"has-vivid-red-color has-text-color\">Control lip\u00eddico :<\/h3>\n\n\n<h5>7. El RCV determina los objetivos, de tal manera que el LDL ser\u00e1 menor de 55, 70 \u00f3 100 mg\/dL en <br>pacientes de muy alto, alto y moderado RCV, respectivamente. Adem\u00e1s los pacientes de alto\/muy alto RCV <br>deben bajar su LDL basal al 50% lo que en la pr\u00e1ctica supone que en estos pacientes se debe iniciar con <br>una estatina de alta potencia y posteriormente se asociar\u00e1 ezetimiba e inhibidores PCSK9 si fuera <br>necesario para alcanzar objetivos.<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" width=\"758\" height=\"64\" src=\"https:\/\/primastcar.com\/wp-content\/uploads\/2021\/09\/decalogo2-1.png\" alt=\"\" class=\"wp-image-887\"\/><\/figure>\n\n\n<h5>8. En pacientes diab\u00e9ticos con hipertrigliceridemia el primer tratamiento ser\u00e1 una estatina junto a la <br>p\u00e9rdida de peso, abstinencia de alcohol y un \u00f3ptimo control gluc\u00e9mico. Debe as\u00ed mismo descartarse <br>procesos concomitantes que justifiquen niveles de triglic\u00e9ridos elevados (hipotiroidismo\u2026). Los fibratos <br>asociados a estatinas no mejoran el RCV.<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<h3 class=\"has-vivid-red-color has-text-color\">Control de hipertensi\u00f3n arterial:<\/h3>\n\n\n<h5>9. El objetivo general de tensi\u00f3n arterial es &lt;130\/80, evitando situaciones de hipotensi\u00f3n (&lt;120\/70). En <br>ancianos el objetivo es &lt; 139\/80. El f\u00e1rmaco inicial ser\u00e1 un IECA\/ARA II y en muchas situaciones precisar\u00e1 <br>tratamiento combinado con antagonistas del calcio o diur\u00e9tico.<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<h3 class=\"has-vivid-red-color has-text-color\">Abordaje global e implicaci\u00f3n del paciente:<\/h3>\n\n\n<h5>10. Todas las gu\u00edas insisten en un abordaje global del paciente diab\u00e9tico y el empoderamiento de este <br>(consciente y controlador de su propia enfermedad). Se debe promover la abstenci\u00f3n absoluta de tabaco, <br>ejercicio f\u00edsico regular y una dieta saludable.<\/h5>\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<\/p>\n<p>\n\n\n<p><\/p>\n\n\n<h3 class=\"has-black-color has-text-color\"><em>Referencias:<\/em><\/h3>\n\n\n\n<ol><li>Gu\u00edas ESC diabetes y enfermedades cardiovasculares 2019. Disponible en: https:\/\/academic.oup.com\/eurheartj\/article\/<br>41\/2\/255\/5556890<\/li><li>Gu\u00edas ADA 2021.Disponible en: https:\/\/care.diabetesjournals.org\/content\/44\/Supplement_1 1<\/li><\/ol>\n\n\n\n<div class=\"wp-block-columns\">\n<div class=\"wp-block-column\">\n<div class=\"wp-block-buttons\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link has-white-color has-vivid-red-background-color has-text-color has-background\" href=\"https:\/\/primastcar.com\/wp-content\/uploads\/2021\/09\/decalogodmprimastcar.pdf\"><strong>DESCARGAR DEC\u00c1LOGO<\/strong><\/a><\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>AUTORES:&nbsp;Dr. Jes\u00fas Mar\u00eda de la Hera. Cardi\u00f3logo en HUCA y Centro M\u00e9dico de Asturias. Expresidente de la SAC. y Dr. Rub\u00e9n Villa. M\u00e9dico de Familia en CS Grado. Presidente de SAMFYC. Riesgo Cardiovascular: 1. La estratificaci\u00f3n del riesgo cardiovascular (RCV) es b\u00e1sica en el manejo del paciente diab\u00e9tico. Existenpacientes de moderado, alto y muy alto&#8230;<\/p>\n<p class=\"more-link\"><a href=\"https:\/\/primastcar.com\/?p=884\"><span>Leer m\u00e1s<\/span><i>&#43;<\/i><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[9,6],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v16.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>DEC\u00c1LOGO DE RECOMENDACIONES B\u00c1SICAS EN DIABETES<\/title>\n<meta name=\"description\" content=\"DEC\u00c1LOGO DE RECOMENDACIONES B\u00c1SICAS EN DIABETES: RESUMEN DE LAS GU\u00cdAS EUROPEA Y AMERICANA DE PR\u00c1CTICA CL\u00cdNICA\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/primastcar.com\/?p=884\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta 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