A new concept makes its way in the field of diabetes.It is that of the early individualization of the treatment, that is, the prescription of the drug most appropriate to the profile of each patient as soon as possible.The objective is to prevent, significantly and from the beginning, the appearance of some of the most common problems associated with diabetes, such as hypertension, hypoglycemia or overweight, and, with them, the risk of comorbidities such as cardiovascular diseases ormicrovascular complications.
This has been revealed in various presentations held, with the collaboration of Novo Nordisk, in the recent XXXV National Congress of the Spanish Society of Internal Medicine (SEMI), which has taken place in Murcia and in which -explains the vice president of theSEMI, Dr. Antonio Zapatero- “great care has been paid to diabetes because internal medicine professionals attend, in consultation, many patients with this disease due to their high cardiovascular risk and, in the hospital, to a large numberof admitted for acute complications of it ”.
The tendency to early individualization grows in parallel to the development of new antidiabetic treatments-the analogues of LPG-1 and the combination of these with basal insulins-that provide additional benefits such as the reduction of the risk of hypoglycemia, flexibility in the administration in the administrationor weight loss.Such benefits allow precisely simulting from very early phases the adequate glycemic control of the patient with the minimization of the appearance of complications.
The analogues of LPG-1 are drugs that act through the receptor of the incredine of the same name, a responsible hormone, among other things, to stimulate insulin secretion.They also contribute to the decrease in the weight of the patient and its blood pressure, and all this with a low risk of hypoglycemia.Therefore, in his LGP-1 paper after metformin: consolidated experience after years of treatment of diabetes mellitus, Dr. Juan José Gorgojo, an attached doctor of the Endocrinology Service of the Alcorcón Foundation University Hospital, has advocated “having them present inA second therapeutic step for immediate prescription when an inappropriate glycemic control is observed in the patient treated with metformin, the usual first -line therapy ”.
"In the specific case of internist doctors," explained Dr. Gorgojo, "have an ally to control the glycemia, weight and cardiovascular risk of their patients with diabetes at the same time.It is true that hospital stay is not the best time to prescribe these drugs for the first time, since patients are there due to diseases that, in many cases, alter their oral tolerance, so the possibility of nausea would increase, nausea, nausea,But it is considered to do so when discharged, depending on their characteristics, obesity, hypertension or risk of hypoglycemia, or if their glycemic control is not adequate, informing the primary care doctor or the specialist who usually treats them. ”
Dr. Juan Francisco Merino, head of the Endocrinology and Nutrition Service of the University Hospital I Politècnic La Fe of Valencia, has agreed that “there is increasing conviction among the specialists that, as soon as we start treating the patient with diabetesWith the drug that best suits its specific characteristics, better results we will obtain in the long term.Hence the convenience of quickly making the leap to the second therapeutic step as soon as it is detected that the objectives pursued are not being achieved.For example, a patient treated with metformin who presents obesity should pass to LPG-1.If it is thinner, to a basal insulin.Yeahvaried circumstances coincide, to the combination of both ”.
In its Paper Insulins and Inclic, a combination for the future?, Dr. Merino has precisely stated the current situation of research around the combination of LPG-1 anologists with basal insulins, combination with whichIt is sought to provide patients with the advantages of both types of drugs: glycemic control along with lower risk of hypoglycemia, weight loss and preservation of beta function, that is, of the ability of the pancreas to secrete insulin.
According to this specialist, “the most advanced combination today, with phase 3b trials, is Ideglira, which mixes liraglutida, an analogue of LPG-1, with the insulin Degludec.The tests are concluding that double glycemic control effect plus added benefits such as weight loss or the lowest number of hypoglycemia.In addition, its presentation allows the two products to be administered in a single puncture.And the half -life of both makes such administration very flexible, being able to be carried out at any time of the day, although it is recommended in the morning. ”