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Vol. 42. Núm. S1.
El reto del manejo diario de la diabetes tipo 2 en atención primaria
Páginas 2-8 (septiembre 2010)
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Vol. 42. Núm. S1.
El reto del manejo diario de la diabetes tipo 2 en atención primaria
Páginas 2-8 (septiembre 2010)
El reto del manejo diario de la diabetes tipo 2 en atención primaria
Acceso a texto completo
Diagnóstico y control de la diabetes mellitus tipo 2
Diagnosis and management of type 2 diabetes
Visitas
5837
Javier Díez Espino
EAP, Tafalla, Navarra, España
Facultad de Medicina, Universidad de Navarra, Pamplona, España
Grupo de Trabajo de Diabetes semFYC; Grupo de Estudio de Diabetes en Atención Primaria de Salud de Navarra, SNMFyAP y RedGEDAPS
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La Asociación Americana de Diabetes ha incluido en 2010 la determinación de la hemoglobina glucosilada (HbA1c) como criterio para el diagnóstico de diabetes con un punto de corte ≥ 6,5%, pero puede tener un porcentaje relevante de falsos negativos. Otras sociedades científicas han aceptado con matices dicho posicionamiento. La HbA1c complementa, pero no sustituye, a la glucemia basal como prueba de cribado y diagnóstico, ni a la determinación de glucosa tras 2 h de la sobrecarga oral de glucosa. La HbA1c no debe emplearse para el diagnóstico de diabetes gestacional. Su interpretación tiene limitaciones en casos de personas con anemias y hemoglobinopatías, por lo que se deben valorar, además de su sensibilidad y especificidad, los costes y el ambiente epidemiológico. ¿Es útil y seguro llevar a nuestros pacientes con diabetes mellitus tipo 2 a valores de HbA1c cercanos a la normalidad? Los resultados de los estudios ACCORD, ADVANCE y VADT son contradictorios y han generado una considerable polémica, pero las prolongaciones de los estudios UKPDS y STENO-2 han demostrado los beneficios de un buen control a largo plazo. Como norma general, parece adecuado un objetivo de HbA1c < 7%. En pacientes con poco riesgo de hipoglucemias, corta evolución de la enfermedad y jóvenes podemos plantearnos una HbA1c < 6,5%. En pacientes con frecuentes hipoglucemias, ancianos o personas con expectativas de vida limitadas serían aceptables cifras superiores al 7%. Este objetivo deberemos conseguirlo mediante un tratamiento individualizado, de inicio temprano, intensivo, seguro y sin riesgo de hipoglucemia, integrándolo en un programa global de prevención de riesgo cardiovascular.

Palabras clave:
Diabetes tipo 2
Diagnóstico
HbA1c
Control glucémico
Abstract

In 2010, the American Diabetes Association included glycosylated hemoglobin (HbA1c) as a criterion for the diagnosis of diabetes with a cut-off point of ≥ 6.5%. However, there may be a substantial percentage of false negative results. Other scientific societies have accepted this approach but with slight differences. HbA1c complements, but does not substitute, basal glycemia as a screening and diagnostic test or the 2-hour oral glucose tolerance test. HbA1c should not be used for the diagnosis of gestational diabetes.

Interpretation of HbA1c is limited in persons with anemia and hemoglobinopathies. Therefore, in addition to its sensitivity and specificity, its costs and the epidemiological situation should also be evaluated. An important question is whether almost normal HbA1c levels are safe in patients with type 2 diabetes. The results of the ACCORD, ADVANCE and VADT trials are contradictory and have aroused considerable controversy. However, the extensions of the UKPDS and STENO-2 studies have shown the benefits of good glycemic control in the long term. As a general rule, a target of HbA1c < 7% seems appropriate.

In patients at low risk of hypoglycemic episodes, short disease duration and young persons, HbA1c < 6.5% can be considered. In patients with frequent hypoglycemic episodes, the elderly and persons with short life expectancy, values of more than 7% are acceptable. This target should be achieved through individualized, early, intensive and safe treatment, without risk of hypoglycemia, and should be integrated in an overall program of cardiovascular risk prevention.

Keywords:
Type 2 diabetes
Diagnosis
HbA1c
Glycemic control
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Copyright © 2010. Elsevier España, S.L.. Todos los derechos reservados
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