Insulinoterapia en pacientes con diabetes mellitus tipo 2. Una revisión narrativa

C González-Wong; H Fuentes-Barría; R Aguilera-Eguía

C González-Wong Facultad de Salud. Universidad del Desarrollo (Santiago, Chile)
H Fuentes-Barría Facultad de Salud. Universidad Santo Tomás (Santiago, Chile)
R Aguilera-Eguía Departamento de Salud Pública. Facultad de Medicina. Universidad Católica de la Santísima Concepción (Concepción, Chile)

Palabras clave: Insulina/administración & dosificación, Diabetes mellitus tipo 2/terapia, Hipoglicemiantes/uso terapéutico, Administración del tratamiento farmacológico, Resultado del tratamiento, Chile

Key-words: Insulina/administración & dosificación, Diabetes mellitus tipo 2/terapia, Hipoglicemiantes/uso terapéutico, Administración del tratamiento farmacológico, Resultado del tratamiento, Chile

Palavras chave: Insulina/administração & dosagem, Diabetes mellitus tipo 2/terapia, Hipoglicemiantes/uso terapêutico, Conduta do tratamento medicamentoso, Resultado do tratamento, Chile

Resumen

Introducción: La diabetes mellitus tipo 2 (DM2), es una de las enfermedades crónicas no transmisibles que ha aumentado su incidencia en las últimas décadas en todo el mundo, siendo su tratamiento pautas y esquemas de insulinoterapia. No obstante, la gran disponibilidad comercial y el control glucémico atribuido a la insulinoterapia ha generado múltiples confusiones en los usuarios y el personal de salud. Objetivo: Describir las pautas y esquemas en el tratamiento de la DM2. Desarrollo: La evolución tecnológica de la insulinoterapia conlleva el uso de múltiples análogos. Dentro de estos destacan los inhalatorios y premezclas por su eficacia en el control glucémico a través del tiempo, considerando las pautas de administración subcutánea en estas premezclas una serie de elementos como la zona de punción, seguridad y uso de pliegues. Dichas pautas han inducido la creación de diversos esquemas de insulinoterapia entre los que se destacan los métodos de acción intensiva y acción móvil, orientados a la simulación de la insulina fisiológica como mecanismo de acción para el control glucémico. La seguridad de estos mecanismos depende del sistema público de salud chileno para la dosificación, administración y control suministrado. Conclusión: Las pautas y esquemas de insulinoterapia sugieren el uso de análogos de acción prolongada ante hiperglucemia; su uso requiere conocimiento integral de los pacientes y cuidadores con el fin de evitar efectos adversos. Los hallazgos de esta revisión deben ser considerados con cautela al momento de tomar decisiones clínicas producto de las limitaciones metodológicas propias del diseño utilizado

Abstract

Introduction: Type 2 diabetes mellitus is one of the non transmissible chronic illnesses which have increased in prevalence during the last decades worldwide. Among the related treatments is the insulin based therapy. Nevertheless, the multiple and diverse controlled and commercial options of this therapy have generated confusion among both the users and health staff. Objective: To describe some insulin-based therapy approaches to type 2 diabetes mellitus. Development: The related technological advances have produced new diverse analog forms of insulin-based therapies. Among these, inhaling and blended forms can be highlighteddue to their efficacy in glucose control. Among the blended mixture, administration forms are the intensive action and the mobile action ones, which can use a human insulin analog as the key therapy element. The public systems, including the Chilean, have an important security role in the supervision and monitoring of the proper and correct dose administrations. Conclusion: The diverse forms of insulin-based therapies for patients with type 2 diabetes mellitus include those with prolonged action insulin analogs but their use should be based on integral knowledge in order to avoid adverse effects. The findings of this review should be considered with caution due to the methodological limitations derived from the study design

Resumo

Introdução: O diabetes mellitus tipo 2 (DM2), é uma das doenças crônicas não transmissíveis que tem aumentado sua incidência nas últimas décadas no mundo todo, sendo suas diretrizes de tratamento e esquemas de insulinoterapia. No entanto, a grande disponibilidade comercial e o controle glicêmico atribuído à insulinoterapia têm gerado múltiplas confusões em usuários e profissionais de saúde. Objetivo: Descrever as diretrizes e esquemas no tratamento do DM2. Desenvolvimento: A evolução tecnológica da insulinoterapia envolve o uso de múltiplos análogos. Dentre estes, os inalantes e pré-misturas destacam-se por sua eficácia no controle glicêmico ao longo do tempo, considerando as orientações de administração subcutânea nessas pré-misturas uma série de elementos como área de punção, segurança e uso de dobras. Essas diretrizes levaram à criação de diversos esquemas de insulinoterapia, dentre os quais se destacam os métodos de ação intensiva e ação móvel, visando simular a insulina fisiológica como mecanismo de ação para o controle glicêmico. A segurança desses mecanismos depende do sistema de saúde pública chileno para a dosagem, administração e controle fornecidos. Conclusão: Diretrizes e esquemas de insulinoterapia sugerem o uso de análogos de longa ação na hiperglicemia; seu uso requer conhecimento abrangente dos pacientes e cuidadores a fim de evitar efeitos adversos. Os achados desta revisão devem ser considerados com cautela ao tomar decisões clínicas devido às limitações metodológicas do desenho utilizado

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Insulinoterapia en pacientes con diabetes mellitus tipo 2. Una revisión narrativa

Insulin based therapy in patients with type 2 diabetes mellitus. A narrative review

Insulinoterapia em pacientes com diabetes mellitus tipo 2. Uma revisão narrativa

Resumen

Abstract

Resumo

Bibliografía