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Protocolo terapéutico de la diabetes mellitus tipo 2 con nefropatía 2 型糖尿病合并肾病的治疗方案
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
{"title":"Protocolo terapéutico de la diabetes mellitus tipo 2 con nefropatía","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.015","DOIUrl":"10.1016/j.med.2024.10.015","url":null,"abstract":"<div><div>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<!--> <!-->&lt;<!--> <!-->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.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1139-1143"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Etiopatogenia y situación epidemiológica de la diabetes mellitus tipo 1 1 型糖尿病的发病机理和流行病学
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.001
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Etiopatogenia y situación epidemiológica de la diabetes mellitus tipo 1","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.001","DOIUrl":"10.1016/j.med.2024.10.001","url":null,"abstract":"<div><div>Type 1 diabetes mellitus (DM1) accounts for 5%-10% of diabetes cases worldwide. In most patients, the pathogenesis is the autoimmune destruction of pancreatic beta cells; in a small percentage, the origin is idiopathic. Although its onset is more common in children, it can also appear in adults, in whom the course is usually slower. Three phases or stages of DM1 have been defined. Virtually all patients with two or more antibodies will develop clinical DM1 (stage 3). In regard to DM1 prevention, there are multiple therapies under study that are aimed at halting the immunologic process or preserving the beta cell. Only teplizumab has been approved by the FDA in stage 2 DM1. The typical clinical symptoms in the diagnosis of DM1 is diabetic ketoacidosis (DKA), which is considered a medical emergency that requires the administration of insulin for its resolution. The determination of autoantibodies in relatives of patients with DM1 has increased the detection of cases of preclinical or asymptomatic DM1 and the need for universal screening for DM1 is being proposed.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1045-1054"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo terapéutico de la hipoglucemia en el paciente con diabetes mellitus tipo 1 1 型糖尿病患者低血糖治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.008
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Protocolo terapéutico de la hipoglucemia en el paciente con diabetes mellitus tipo 1","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.008","DOIUrl":"10.1016/j.med.2024.10.008","url":null,"abstract":"<div><div>This clinical protocol for the management of hypoglycemia in patients with type 1 diabetes mellitus details intervention strategies that are especially focused on the treatment of hypoglycemic episodes. In addition, it emphasizes the importance of patient and medical team education in order to optimize the management and prevention of severe hypoglycemia, which can have serious implications.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1093-1096"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complicaciones crónicas de la diabetes mellitus tipo 1 1 型糖尿病的慢性并发症
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.003
J.B. Quiñones Silva , A. Bayona Cebada , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Complicaciones crónicas de la diabetes mellitus tipo 1","authors":"J.B. Quiñones Silva ,&nbsp;A. Bayona Cebada ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.003","DOIUrl":"10.1016/j.med.2024.10.003","url":null,"abstract":"<div><div>Type 1 diabetes mellitus (DM1) is a chronic disease that predisposes individuals to multiple microangiopathic and macrovascular complications. Microangiopathic complications include diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy, while macrovascular complications include coronary artery disease, cerebrovascular disease, and peripheral artery disease. This update reviews the prevalence, pathogenesis, forms of presentation, diagnosis, and treatment of these complications, emphasizing the importance of screening and early management to prevent progression and improve patients’ quality of life.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1064-1071"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Estrategia terapéutica en el paciente diabético (I). Empoderamiento del paciente y educación. Objetivos terapéuticos. Estilo de vida, alimentación y control de los factores de riesgo cardiovascular. Sistemas de control glucémico 糖尿病患者的治疗策略（I）。患者赋权与教育。治疗目标。生活方式、饮食和心血管风险因素的控制。血糖控制系统
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.010
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Estrategia terapéutica en el paciente diabético (I). Empoderamiento del paciente y educación. Objetivos terapéuticos. Estilo de vida, alimentación y control de los factores de riesgo cardiovascular. Sistemas de control glucémico","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.010","DOIUrl":"10.1016/j.med.2024.10.010","url":null,"abstract":"<div><div>Managing type 2 diabetes (DM2) requires a multifactorial approach. The foundation of treatment is lifestyle modification and diabetes education. Patients must be involved in decision making and be given tools to help them manage their disease. The four basic pillars of DM2 management are: a) glycemic control; b) blood pressure management; c) lipid management; and d) use of drugs with proven cardiovascular and renal benefits. In terms of lifestyle, it is recommended to combine a diet that contributes to weight maintenance and glycemic control as well as the incorporation of regular moderate physical activity (at least 150<!--> <!-->minutes per week). Cholesterol and blood pressure targets should be individualized for each patient with DM2 based on the presence of cardiovascular disease or cardiovascular risk. Smoking cessation is recommended. There are two main glycemic control systems: blood glucose monitoring (capillary glycemia) and continuous glucose monitoring.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1107-1115"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Tecnología aplicada a la diabetes 应用于糖尿病的技术
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.004
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Tecnología aplicada a la diabetes","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.004","DOIUrl":"10.1016/j.med.2024.10.004","url":null,"abstract":"<div><div>Diabetes technology refers to devices and applications that people with diabetes use to help manage their disease. There are two main categories: blood glucose monitoring systems (including continuous glucose monitoring (CGM) systems) and insulin delivery devices (including insulin pumps and smart insulin pens). CGM devices measure interstitial blood glucose continuously or intermittently (flash measurements), showing alerts and trends that help predict glucose behavior. The data are represented by the ambulatory glucose profile, which provides measurements and a summary graph to aid in its interpretation. Insulin pumps or continuous subcutaneous insulin infusion systems are devices that infuse rapid-acting insulin continuously with the objective of maintaining glucose levels in range. Among these, hybrid closed loop systems are capable of adjusting insulin infusion according to CGM blood glucose figures. Smart insulin pens are linked to smartphone apps and have features that help patients manage their diabetes (dose reminder, bolus calculator, active insulin monitoring).</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1072-1080"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico y terapéutico de la diabetes en el embarazo 妊娠糖尿病的诊断和治疗方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.013
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Protocolo diagnóstico y terapéutico de la diabetes en el embarazo","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.013","DOIUrl":"10.1016/j.med.2024.10.013","url":null,"abstract":"<div><div>This clinical protocol addresses the diagnosis and treatment of diabetes during pregnancy, distinguishing between pregestational diabetes and gestational diabetes (GD). GD occurs when pancreatic beta cell function is insufficient to overcome the inherent insulin resistance of pregnancy. Universal screening is recommended between 24–28 weeks of gestation using two strategies: a one-step strategy (75<!--> <!-->g of glucose) or a two-step strategy (50<!--> <!-->g of glucose followed by 100<!--> <!-->g if the first test is abnormal). Management includes capillary glucose monitoring, diet, and exercise as well as insulin treatment if necessary. Patients should be screened for metabolic abnormalities 4–12 weeks after delivery.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 19","pages":"Pages 1131-1134"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interpretación de la monitorización continua de glucosa 持续葡萄糖监测的解读
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.005
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Interpretación de la monitorización continua de glucosa","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.005","DOIUrl":"10.1016/j.med.2024.10.005","url":null,"abstract":"<div><div>This protocol analyzes the interpretation of continuous glucose monitoring (CGM) data, highlighting the ambulatory glucose profile (AGP) as a key tool for diabetes management. Parameters such as time in range (TIR), glycemic variability, and the risks associated with hyperglycemia and hypoglycemia are discussed. The goal is to improve clinical decision-making and educate patients with standardized metrics for different patient groups, such as pregnant women and older adults.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1081-1084"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo diagnóstico diferencial de otras diabetes diagnosticadas en la juventud 青少年其他糖尿病的鉴别诊断方案
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.007
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Protocolo diagnóstico diferencial de otras diabetes diagnosticadas en la juventud","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.007","DOIUrl":"10.1016/j.med.2024.10.007","url":null,"abstract":"<div><div>This protocol focuses on the differential diagnosis of type 1 diabetes mellitus (DM1) in young patients, emphasizing that though DM1 is the most common form of diabetes in this population, other forms of diabetes, such as type 2 diabetes (DM2) and monogenic diabetes, should be considered. The diagnostic process entails differentiation between DM1; DM2; and other rare forms such as monogenic diabetes, diabetes of the exocrine pancreas, or drug-induced diabetes. Clinical factors and findings, such as negativity for pancreatic autoimmunity, body mass index (BMI), and family history, are described in order to help differentiate these conditions. A diagnostic algorithm is included to guide the clinical evaluation and the importance of performing genetic studies in suspected cases of monogenic diabetes is described. This protocol highlights the importance of a comprehensive evaluation to ensure an accurate diagnosis in young patients with diabetes.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1089-1092"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Protocolo terapéutico y seguimiento del paciente con diabetes mellitus tipo 1 y obesidad 1 型糖尿病和肥胖症患者的治疗方案和随访
Medicine - Programa de Formación Médica Continuada Acreditado Pub Date : 2024-10-01 DOI: 10.1016/j.med.2024.10.006
A. Bayona Cebada , J.B. Quiñones Silva , H.F. Escobar-Morreale , L. Nattero Chávez
{"title":"Protocolo terapéutico y seguimiento del paciente con diabetes mellitus tipo 1 y obesidad","authors":"A. Bayona Cebada ,&nbsp;J.B. Quiñones Silva ,&nbsp;H.F. Escobar-Morreale ,&nbsp;L. Nattero Chávez","doi":"10.1016/j.med.2024.10.006","DOIUrl":"10.1016/j.med.2024.10.006","url":null,"abstract":"<div><div>Treatment protocol and follow-up of patients with type 1 diabetes and obesity This protocol focuses on the management of obesity in patients with type 1 diabetes mellitus (DM1), a growing problem due to factors such as lifestyle, insulin treatment, and hypoglycemia. The approach includes four key pillars: nutrition therapy, drug therapy, physical activity, and management of insulin therapy. Nutrition therapy is the first line of treatment and is based on calorie reduction and a diet rich in fiber. In addition, there are pharmacological options for the management of overweight in patients with DM1, although they have specific challenges, such as euglycemic diabetic ketoacidosis. Physical activity and the adjustment of insulin therapy also play an essential role in weight and glycemic control. In severe cases, bariatric surgery is a viable option for patients with severe obesity.</div></div>","PeriodicalId":100912,"journal":{"name":"Medicine - Programa de Formación Médica Continuada Acreditado","volume":"14 18","pages":"Pages 1085-1088"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142426538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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