Protocolo terapéutico de la diabetes mellitus tipo 2 con nefropatía

Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI:10.1016/j.med.2024.10.015

A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez

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Abstract

The protocol describes the therapeutic management of patients with type 2 diabetes mellitus (DM2) and chronic kidney disease (CKD), a frequent complication in 20%–40% of individuals with DM2. Treatment is based on blood pressure control (target < 130/80 mmHg); angiotensin-converting enzyme inhibitors (ACE inhibitors) or angiotensin II receptor blockers (ARBs) are recommended. For glycemic control, the glycosylated hemoglobin (HbA1c) level sought is individualized for each patient, but is generally below 7%, adjusting the medication according to the patient's estimated glomerular filtration rate (eGFR). Sodium-glucose cotransporter-2 (SGLT-2i) inhibitors and glucagon-like peptide-1 agonists (GLP-1a) are recommended for their renal and cardiovascular benefits. In addition, patients with CKD and DM2 should be treated with statins to reduce cardiovascular risk, avoiding drugs that increase the risk of hypoglycemia. Individualized treatment and frequent monitoring are essential, especially in patients with decreased eGFR and persistent albuminuria.

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2 型糖尿病合并肾病的治疗方案

该方案介绍了对 2 型糖尿病（DM2）和慢性肾脏病（CKD）患者的治疗管理，慢性肾脏病是 2 型糖尿病患者的常见并发症，占 DM2 患者的 20%-40% 。治疗以控制血压为基础（目标值为 130/80 mmHg）；推荐使用血管紧张素转换酶抑制剂（ACE 抑制剂）或血管紧张素 II 受体阻滞剂（ARB）。在血糖控制方面，每位患者所寻求的糖化血红蛋白（HbA1c）水平都是因人而异的，但一般都低于 7%，并根据患者的肾小球滤过率（eGFR）进行药物调整。推荐使用钠-葡萄糖共转运体-2（SGLT-2i）抑制剂和胰高血糖素样肽-1激动剂（GLP-1a），因为它们对肾脏和心血管有益。此外，CKD 和 DM2 患者应使用他汀类药物治疗，以降低心血管风险，同时避免使用会增加低血糖风险的药物。个体化治疗和频繁监测至关重要，尤其是对于 eGFR 下降和持续白蛋白尿的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medicine - Programa de Formación Médica Continuada Acreditado

CiteScore

0.30

自引率

0.00%

发文量