La diabetes mellitus (DM) es una enfermedad metabólica crónica que está adquiriendo en los últimos años proporciones de auténtica epidemia. Se asocia frecuentemente con obesidad, alteraciones del metabolismo lipídico y proteínico, así como con hipertensión arterial y otros factores de riesgo cardiovascular, lo que constituye el síndrome metabólico. La DM tipo 2 (DM2) es un factor de riesgo importante para la enfermedad coronaria y la aterosclerosis precoz. Su etiopatogenia es multifactorial y está muy relacionada con la resistencia insulínica (RI), que es el proceso fisiopatológico común al conjunto de factores de riesgo cardiovascular. Respecto a la prevención y el tratamiento de la DM2, es fundamental la modificación del estilo de vida, con especial hincapié en la alimentación equilibrada y la introducción del ejercicio físico aeróbico en la vida cotidiana. Cuando las pautas higiénico- dietéticas no son suficientes, se debe recurrir a fármacos que actúen sobre la diana de la resistencia insulínica, como la metformina y las tiazolidinas.
Palabras clave
Diabetes mellitus tipo 2
Síndrome metabólico
Riesgo cardiovascular
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Bibliografía
[1.]
P. Zimmet, K.G. Alberti, J. Shaw.
Global and societal implications of the diabetes epidemic.
Nature, (2001), 414 pp. 782-787
[2.]
American Diabetes Association.
Standars of Medical Care in Diabetes.
Diabetes Care, (2005), 28 pp. S4-S36
[3.]
A. Goday, M. Serrano-Ríos.
Epidemiología de la diabetes mellitus en España. Revisión crítica y nuevas perspectivas.
Med Clin (Barc), (1994), 102 pp. 306-315
[4.]
D. Molnár.
The prevalence of the metabolic syndrome and type 2 diabetes mellitus in children and adolescents.
Int J Obesity, (2004), 28 pp. S70-S74
[5.]
Expert Panel on Detection, Evaluation, And treatment of High Blood Cholesterol in Adults: executive summary of the Third Report of the National Cholesterol Education program (NECP) Expert Panel on Detection, evaluation, and Treatment of High Blood Choloesterol in Adults (Adult Treatment Panel III).
JAMA, (2001), 285 pp. 2486-2497
[6.]
The European Group for the study of Insulin Resistance.
The frequency of the WHO Metabolic Syndrome in Europen Cohorts, and an alternative definition of an insulin Resistance Syndrome.
Diabet Med, (2002), 28 pp. 364-376
[7.]
M.P. Stern, K. Willians, C. González-Villalpando, K.J. Hunt, S.M. Haffner.
Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease?.
Diabetes Care, (2004), 11 pp. 2676-2681
[8.]
C. Lorenzo, M. Okoloise, K. Willians, M. Stern, S. Haffner.
The metabolic syndrome an predictor of type 2 diabetes. The San Antonio Heart Study.
Diabetes Care, (2003), 26 pp. 3153-3159
[9.]
E. Bonora, G. Targher, G. Formentini, F. Calcaterra, S. Lombardi, F. Marini, et al.
The metabolic syndrome is an independent predictor of cardiovascular disease in type 2 diabetic subjects. Prospective data from the Verona Diabetes Complications Study.
Diabetic Med, (2003), 21 pp. 52-58
[10.]
J.A. Gimeno Orna, L.M. Lou Arnal, E. Molinero Herguedas, B. Boned Julian, D.P. Portilla Córdoba.
Influencia del syndrome metabólico en el riesgo cardiovascular de pacientes con diabetes tipo 2.
Rev Esp Cardiol, (2004), 57 pp. 507-513
[11.]
American Diabetes Association. The prevention or delay of type 2 diabetes. (position statement) Diabetes Care. 2002;25:742-9. (US Prevention Services Task Force: Screening for type 2 diabetes mellitus in adults: recomendations and rationale. Ann Intern Med. 2003;138:212-4.)
[12.]
H.M. Lakka, T.A. Laaksonen, L.K. Niskanen, E. Kumposalo, J. Tuomilehto, J.T. Salonen.
The metabolic syndrome and total and cardiovascular disease mortality in middle-age men.
JAMA, (2002), 288 pp. 2709-2716
[13.]
H.N. Ginsberg.
Insulin resistance and cardiovascular disease.
J Clin Invest, (2000), 106 pp. 453-458
[14.]
M.J. Martinez Calatrava, M.T. Martinez Larrad, M. Serrano Ríos.
Síndrome de resistencia insulínica y síndrome metabólico: similitudes y diferencias. Síndrome metabólico: concepto, fisiopatología y epidemiología.
Cardiovascular RBK Factores, (2003), 12 pp. 89-95
[15.]
F.S. Facchini, A. Riccardo, A. Stoohs, G.M. Reaven.
Enhanced sympathetic nervous system activity: the linchpin between insulin resistance, hyperinsulinemia and heart rare.
Am J Hypertens, (1996), 9 pp. 1013-1017
[16.]
M. Stumvoll, B.J. Goldstein, T.W. Haeften.
Type 2 diabetes: principles of pathogenesis and therapy.
Lancet, (2005), 365 pp. 1333-1346
[17.]
J.R. Zierath, A. Krook, H. Wallberg-Henriksson.
Insulin action and insulin resistance in human skeletal muscle.
Diabetologia, (2000), 43 pp. 821-835
[18.]
M. Axelseri, U. Smith, J.W. Erifsson, M.R. Taskinen, P.A. Jansson.
Posprandial hypertriglyceridemia and insulin resístanse in normoglycemic first-degree relatives of patients with type 2 diabetes.
Ann Intern Med, (1999), 131 pp. 27-31
[19.]
S.E. Kahn.
The importance of the beta-cell in the pathogenesis of type 2 diabetes mellitus.
Am J Med, (2000), 108 pp. S2-S8
[20.]
C. Weyer, C. Bogardus, D.M. Mott, R.E. Pratley.
The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus.
J Clin Invest, (1999), 104 pp. 787-794
[21.]
Diabetes Prevention Program Research Group.
Reduction in incidence of type 2 diabetes with lifestyle intervention or Metformin.
N Engl J Med, (2002), 346 pp. 393-403
[22.]
J. Tuamiletho, J. Undstrom, J.G. Ericsson, T.T. Valle, H. Hamalainen, P. Lanne-Parikka.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjets with impired glucosa tolerance.
N Engl J Med, (2001), 344 pp. 1343-1350
[23.]
J.L. Chiason, R. Gomis, M. Hanefeld, R.G. Josse, A. Karasik, M. Laakso.
The Stop-NIDDM Trial: an internacional study on the efficacy o fan alpha-glucosidase inhibitor to prevent type 2 diabetes in a population with impaired glucosa tolerance. Rationale, design and preliminary screening data. Study to Prevent Non-Insulin-Dependent Diabetes Mellitus.
Diabetes Care, (1998), 346 pp. 393-403
[24.]
UK Prospective Diabetes Study (UKPDS) Group.
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34).
Lancet, (1998), 352 pp. 854-865
[25.]
T.A. Buchanan, A.H. Xiang, R.K. Peters.
Protection from type 2 diabetes persists in the TRIPOD cohort eight months alter stopping troglitazone.
Diabetes, (2001), 50 pp. A81
[26.]
Heart OutcomesPrevention Evaluation (HOPE) Study Investigators.
Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of de HOPE study and MICRO-HOPE substudy.
Lancet, (2000), 355 pp. 253-259
[27.]
American Diabetes Association.
Phisical activity/exercise and diabetes mellitus (position statement).
Diabetes Care, (2003), 26 pp. S73-S77
[28.]
Consenso del Grupo de Trabajo: Resistencia a la Insulina de la Sociedad Española de Diabetes.
La resistencia a la insulina y su implicación en múltiples factores de riesgo asociados a diabetes mellitus tipo 2.
Med Clin (Barc), (2002), 119 pp. 458-463
[29.]
J. Steppel, E. Horton.
Exercise in patients with type 2 diabetes.
Diabetes mellitus: a fundamental and clinical text, Lippincott-Raven, pp. 1099-1105
[30.]
American Diabetes Association.
Nutrition principles and recommendations in diabetes (Position Statement), (2004), 27 pp. S36-S46
[31.]
R.S. Rosenson, C.A. Reasner.
Therapeutic approaches in the prevention of cardiovascular disease in metabolic syndrome and in patients with type 2 diabetes.
Curr Opin Cardiol, (2004), 19 pp. 480-487
[32.]
E. Berger, D.E. Moller.
The mechanisms of action of PPARs.
Annu Rev Med, (2002), 53 pp. 409-435
[33.]
H. Yki-Järvinen.
Thiazolidinediones.
N Engl J Med, (2004), 351 pp. 1106-1118
[34.]
Y. Miyazaki, L. Glass, C. Triplitt, M. Matsuda, K. Cusi, A. Mahankali, et al.
Effect of rosiglitazone on glucose and non-esterified fatty acid metabolism in type 2 diabetic patients.
Diabetologia, (2001), 44 pp. 2210-2219
[35.]
Y. Miyazaki, A. Mahankali, M. Matsuda.
Effect of pioglitazone on abdominal fat distribution and insulin sensitivity in type 2 diabetic patients.
J Clin Endocrinol Metab, (2002), 87 pp. 2784-2791
[36.]
F. Picard, J. Auwerx.
PPAR(gamma) and glucose homeostasis.
Annu Rev Nutr, (2002), 22 pp. 167-197
[37.]
R.W. Nesto, D. Bell, R.O. Bonow, V. Fonseca, S.M. Grundy, E.S. Horton, et al.
Thiazolindinedione. Use, fluid retention, and congestive heart failure. A consensus statement from the American Herat Association and American Diabetes Association.
Circulation, (2003), 108 pp. 2941-2948
[38.]
B. Kimmel, S.E. Inzucchi.
Oral agents for type 2 diabetes: an update.
Clin Diab, (2005), 23 pp. 64-76
[39.]
H.E. Lebovitz.
Oral therapie for diabetic hyperglycemia.
Endocrinol Metab Clin N Am, (2001), 30 pp. 909-933
[40.]
H.E. Lebovitz.
Secretagogos de la insulina: sulfonilureas, repaglinida y nateglinida. Tratamiento de la diabetes mellitus y sus complicaciones 1.
Medical Trens SL, (2005),
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