Enfoque terapéutico de la diabetes mellitus tipo 2 en adultos. Más allá de una meta glucémica
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La diabetes mellitus tipo 2 es una enfermedad que cada día incrementa su incidencia y prevalencia. Se estima que más de 400 millones de personas tienen esta enfermedad y muchos desconocen su diagnóstico. La diabetes mellitus produce desenlaces microvasculares y macrovasculares desfavorables. A lo largo de los años se ha encontrado que el control intensivo de la glucemia tiene beneficios sobre los desenlaces microvaculares; sin embargo, no se había logrado demostrar desenlaces macrovasculares satisfactorios hasta los últimos años cuando gracias a nuevas moléculas se demostró dicho beneficio. Es por esto que el enfoque terapéutico de la diabetes mellitus tipo 2 ha cambiado, ahora no solo es lograr una meta en hemoglobina glicada (HbA1c), sino también lograr disminuir el riesgo cardiovascular con el objetivo de disminuir eventos micro y especialmente macrovasculares. En los últimos años se han identificado nuevas dianas terapéuticas para el tratamiento de esta entidad, con el desarrollo de moléculas que además de haber demostrado un control glucémico aceptable, también representan seguridad cardiovascular, incluso algunas han confirmado disminuir el riesgo cardiovascular. A lo largo del artículo se discute la importancia del riesgo cardiovascular en la población con diabetes mellitus tipo 2 y los esquemas terapéuticos disponibles para impactar sobre este riesgo.
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