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Regarding renal results, the slow progression of the renal disease would require long-term trials with a high number of patients to identify its clinical benefits, thus what are normally used are intermediate result variables, such as moving from microalbuminuria to macroalbuminuria or the doubling of serum creatinine to assess the progression of nephropathy. Most of type 2 diabetic patients with or without microalbuminuria will die before due to cardiovascular reasons rather than to renal causes. In fact, the greatest benefit of treating these patients is achieved through the reduction of cardiovascular events (211). A Cochrane review (212) concludes that only the ACE-inhibitors have proved to prevent the development of microalbuminuria (NNT 25), although it is not yet clear if there are differentiating effects with other anti-hypertensive drugs, with the exception of calcium antagonists, which in this review, have proved to be less effective than the ACE-inhibitors. On the other hand, the independent nephroprotector effects of the ACEinhibitors or ARB-II, beyond blood pressure reduction, have been questioned by a recent meta-analysis (213). In the ALLHAT trial, after a 4.9-year follow-up, no differences were observed between lisinopril, amlodipine and chlorthalidone in the renal result variables, taking into consideration the limitations that nephropathy was not the study’s main aim and that the patients were selected as they had high cardiovascular risk (214). SR of RCT 1+ Evidence summary 1+ There is limited evidence that an intensive blood pressure control is more beneficial among the diabetic population than the non-diabetic (179; 196). 1+ In the subgroup of hypertense DM 2 patients, reducing DBP to less than 80 mmHg implies a reduction of cardiovascular morbimortality (179). 1++ There are no significant differences in cardiovascular mortality among hypertense diabetics treated with chlorthalidone, amlodipine or lisinopril (201). Chlorthalidone has proved to be more effective than lisinopril and amlodipine in the prevention of heart failure. 1+/– ACE-inhibitors have proved to be more effective than calcium channel blockers in the prevention of cardiovascular morbimortality (202; 203). 1+ ARB II is not better than the ACE-inhibitors when reducing cardiovascular mortality among the diabetic population (208). 1++ In hypertense diabetic patients aged between 55 and 80 and with LVH electrocardiographic signs, losartan reduces cardiovascular mortality much more than atenolol (206). 1++ In diabetic patients over 55 years old with another cardiovascular risk factor (including HBP), the use of ramipril 10 mg, added to conventional treatment, reduces cardiovascular morbimortality (210). 1++ ACE-inhibitors are more effective than placebo and than calciumchannel blockers to prevent microalbuminuria (212). 84 CLINICAL PRACTICE GUIDELINES IN THE NHS
Recommendations B/D A B CPG Patients with essential HBP and DM 2 without retinopathy should receive treatment to reduce blood pressure (BP) until they achieve diastolic blood pressure (DBP) _80 mmHg (B) and systolic blood pressure (SBP) _140 mmHg (D). DM 2 hypertense patients without nephropathy should be treated firstly with an angiotensin converting enzyme-inhibitor (ACE) or a thiazide; or both when it is considered necessary to control blood pressure. An alternative treatment are dihydropyridines calcium channel blockers. The use of beta-blockers is not recommended unless there is a firm indication for their use, such as coronary heart disease or heart failure. CLINICAL PRACTICE GUIDELINE ON TYPE 2 DIABETES 85
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Clinical Practice Guideline on type
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A bibliographic record of this work
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Table of Contents Presentation 9 Au
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11. Diabetic foot. Assessment, prev
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Presentation Care practice is becom
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Other collaborations Rosa Rico Itur
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13. Which drug combination strategi
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Summary of recommendations Defi nit
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D CPG B B B B A daily single dose
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A B CPG Hypertense patients with DM
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Treatment for diabetic foot ulcers
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1. Introduction Effective care for
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3. Methodology Methodology. Evidenc
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4. Epidemiology and sanitary impact
Page 35: However, the quality of the assista
Page 38 and 39: 5.2. Risk factors for the developme
Page 40 and 41: 5.2.8. Diet and alcohol Type of die
Page 42 and 43: 5.2.12. Heart failure The associati
Page 44 and 45: The ADA does not recommend it for c
Page 46 and 47: Figure 1. DM 2 diagnostic algorithm
Page 48 and 49: 46 CLINICAL PRACTICE GUIDELINES IN
Page 50 and 51: 6.1. Impaired Fating Glucoseucose (
Page 52 and 53: 1++ An intensive intervention on li
Page 54 and 55: Different SRs (81-84) have assessed
Page 56 and 57: 7.1.4. Other dietary interventions
Page 58 and 59: Exchange system This system is base
Page 60 and 61: duration and intensity). Performing
Page 62 and 63: [RR 0.75 (CI 95%: 0.60-0.93)], and
Page 64 and 65: The optimum dose in most patients i
Page 66 and 67: without heart failure. In this stud
Page 68 and 69: B B B B Metillinides can play a ro
Page 70 and 71: Recommendations B A A B B B B When
Page 72 and 73: 8.2. Insulin therapy 8.2.1. Associa
Page 74 and 75: Slow-acting insulin analogues vs. N
Page 77 and 78: 9. Screening and treatment of macro
Page 79 and 80: The validity and applicability of a
Page 81 and 82: The RCTs and the meta-analysis are
Page 83 and 84: 1+ In primary prevention, aspirin b
Page 85: 9.5.2. Pharmacological treatment of
Page 90 and 91: incidence was 0.3% after the first
Page 92 and 93: it is believed that microalbuminuri
Page 94 and 95: Summary of evidence 1++ In hyperten
Page 96 and 97: An SR on drugs to treat diabetic ne
Page 98 and 99: (241), the response rate to placebo
Page 101 and 102: 11. Diabetic foot. Assessment, prev
Page 103 and 104: 11.2.2. Peripheral arterial disease
Page 105 and 106: 11.4. Other preventive measures The
Page 107 and 108: B D CPG B Diabetic foot screening m
Page 109 and 110: 11.5.4. Antibiotic treatment for in
Page 111: 2+ The culture has a limited value
Page 114 and 115: • Promote healthy lifestyles: die
Page 116 and 117: In another recent RCT (289), sMBG w
Page 118 and 119: 12.3. Contents and methods of an ed
Page 120 and 121: Assessment of self-management recor
Page 122 and 123: 13.4. Referral criteria to medical
Page 125 and 126: Appendices Appendix 1. Levels of Ev
Page 127 and 128: Appendix 2. DM 2 diet Estimating ca
Page 129 and 130: CLINICAL PRACTICE GUIDELINE ON TYPE
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CLINICAL PRACTICE GUIDELINE ON TYPE
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Page 141 and 142:
GPL-1 Analogues Biguanides Glitazon
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Devices FLEXPEN (Novo Nordisk): OPT
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Treatment for an unconscious patien
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Appendix 6. Assessment of macro- an
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Appendix 8. Use of monofilament Mon
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Page 155 and 156:
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Indicators of final outcomes • Nu
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Impaired Glucose Tolerance (IGT): I
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IGT INSIGHT Trial IV LDL LH LIFE Tr
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Bibliography 1. Estrategia en diabe
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33. Iso H, Date C, Wakai K, Fukui M
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64. Screening for type 2 diabetes.
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97. Thomas DE, Elliott EJ, Naughton
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129. Lincoff AM, Wolski K, Nicholls
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157. Natarajan S, Liao Y, Cao G, Li
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185. de GG. Low-dose aspirin and vi
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214. Rahman M, Pressel S, Davis BR,
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245. NZGG. Management of type 2 dia
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279. Norris SL, Nichols PJ, Caspers
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