Consenso ADA-EASD sobre tratamiento de la hiperglucemia
The epidemic of type 2 diabetes in the latter part of the 20th and in the early 21st century, and the recognition that achieving specific glycaemic goals can substantially reduce morbidity, have made the effective treatment of hyperglycaemia a top priority. While the management of hyperglycaemia, the hallmark metabolic abnormality associated with type 2 diabetes, has historically had centre stage in the treatment of diabetes, therapies directed at other coincident features, such as dyslipidaemia, hypertension, hypercoagulability, obesity and insulin resistance, have also been a major focus of research and therapy. Maintaining glycaemic levels as close to the non-diabetic range as possible has been demonstrated to have a powerful beneficial impact on diabetes-specific complications, including retinopathy, nephropathy and neuropathy in the setting of type 1 diabetes; in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce complications.
Intensive glycaemic management resulting in lower HbA1c levels has also been shown to have a beneficial effect on cardiovascular disease (CVD) complications in type 1 diabetes; however, the role of intensive diabetes therapy on CVD in type 2 diabetes remains under active investigation. Some therapies directed at lowering
glucose levels have additional benefits with regard to risk factors, while others lower glucose without additional benefits.
The development of new classes of blood glucoselowering medications to supplement the older therapies, such as lifestyle-directed interventions, insulin, sulfonylureas and metformin, has increased the treatment options for type 2 diabetes. Whether used alone or in combination with other blood glucose-lowering interventions, the availability of the newer agents has provided an increased number of choices for practitioners and patients and heightened uncertainty
regarding the most appropriate means of treating this widespread disease. Although numerous reviews on the management of type 2 diabetes have been published in recent years, practitioners are often left without a clear pathway of therapy to follow. We developed the following consensus approach to the management of hyperglycaemia in the non-pregnant adult to help guide health care providers in choosing the most appropriate interventions for their patients with type 2 diabetes.