advance
TRANSCRIPT
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Intensive Blood Glucose Control and VascularOutcomes in Patients with Type 2 Diabetes
Federico Failach NavarroResidente II Medicina Interna
Universidad del Sinú
n engl j med 358;24 www.nejm.2560 org june 12, 2008
The NEW ENGLAND JOURNAL o f MEDICINE
The ADVANCE Collaborative Group*
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n engl j med 358;24 www.nejm.2560 org june 12, 2008
Metodo
ADVANCE(Ensayo factorial
aleatorizado controlado)
Diagnostico DM tipo 2 (30-55 años)
Micro/macrovascularFactor RCV
Contraindicacion de los medicamentos.
Terapia con insulina largo data
ADVANCE215 CM EN 20 PAISES
n: 11.140
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Metodo
n engl j med 358;24 www.nejm.2560 org june 12, 2008
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n engl j med 358;24 www.nejm.2560 org june 12, 2008
Metodo
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n engl j med 358;24 www.nejm.2560 org june 12, 2008
MetodoRe
sulta
dos
prim
ario • Eventos macrovasculares
• IAM• IAM no fatal• ECV no fatal• Retinopatia• Nefropatia
Resu
ltado
sec
unda
rio
• Eventos microvasculares • Muerte por otras causas• Angina o otros eventos
coronarios• Evento vas. periferico• Demencia• Microalbuminuria• Deterioro visual• Falla cardiaca• otros
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n engl j med 358;24 www.nejm.2560 org june 12, 2008
Control de la glucosa
7.3%6.5%
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Resultados
20.0%
18.1%
n engl j med 358;24 www.nejm.2560 org june 12, 2008
0.90 (95% confidence interval [CI], 0.82 to 0.98)
9.4%
10.9%
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n engl j med 358;24 www.nejm.2560 org june 12, 2008
Resultados
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n engl j med 358;24 www.nejm.2560 org june 12, 2008
Conclusión
• No hubo diferencias significativa tanto en la tasa de eventos macro y microvasculares
• Hubo un beneficio en la aparicion de nefropatia en paciente con tratamiento intensivo?
• Hubo mayor porcentaje de hospitalizacion en pacientes tratamiento intensivo (hipoglicemia)