Diabetes mellitus tipo 2: Consideraciones sobre riesgo y rehabilitación cardiovasculares. Segunda parte

Autores/as

Resumen

La diabetes mellitus tipo 2 se asocia a un incremento del riesgo de mortalidad por enfermedad cardiovascular y es una afección frecuente dentro de los pacientes con enfermedad cardiovascular establecida. El tratamiento adecuado permite mejorar la calidad de vida del paciente y disminuir la morbilidad y la mortalidad por esta y otras causas. La rehabilitación cardiovascular ha demostrado ser una terapéutica eficaz y beneficiosa en los pacientes con diabetes mellitus tipo 2. Por eso, se revisaron 70 referencias bibliográficas con el objetivo de describir elementos importantes sobre su tratamiento, que incluye estrategias farmacológicas, no farmacológicas y la rehabilitación cardiovascular.

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Lázara M. Pérez Yánez, Hospital Hermanos Ameijeiras

Presidenta de la Sección Nacional de Prevención y Rehabilitación Cardiovascular de la Sociedad Cubana de Cardiología.

Jefa de la Sección de Cardiología Diagnóstica del Hospital Hermanos Ameijeiras.

Especialista de Segundo Grado en Cardiología.

Máster en Urgencias Médicas.

Profesora e Investigadora Auxiliar.

Doctora en Ciencias Médicas.

Citas

1. Standards of Medical Care in Diabetes-2017: Summary of Revisions. Diabetes Care. 2017;40(Supl 1):S4-5. DOI: https://doi.org/10.2337/dc17-s003

2. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. Guía ESC 2016 sobre prevención de la enfermedad cardiovascular en la práctica clínica. Rev Esp Cardiol. 2016;69(10):939.e1-87. DOI: https://dx.doi.org/10.1016/j.recesp.2016.09.004

3. Huo R, Du T, Xu Y, Xu W, Chen X, Sun K, et al. Effects of Mediterranean-style diet on glycemic control, weight loss and cardiovascular risk factors among type 2 diabetes individuals: a meta-analysis. Eur J Clin Nutr. 2015;69(11):1200-8. DOI: https://doi.org/10.1038/ejcn.2014.243

4. Wycherley TP, Clifton PM, Noakes M, Brinkworth GD. Weight loss on a structured hypocaloric diet with or without exercise improves emotional distress and quality of life in overweight and obese patients with type 2 diabetes. J Diabetes Investig. 2014;5(1):94-8. DOI: https://doi.org/10.1111/jdi.12120

5. Ley SH, Hamdy O, Mohan V, Hu FB. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. Lancet. 2014;383(9933):1999-2007. DOI: https://doi.org/10.1016/s0140-6736(14)60613-9

6. Dempsey PC, Larsen RN, Sethi P, Sacre JW, Straznicky NE, Cohen ND, et al. Benefits for Type 2 Diabetes of Interrupting Prolonged Sitting With Brief Bouts of Light Walking or Simple Resistance Activities. Diabetes Care. 2016;39(6):964-72. DOI: https://doi.org/10.2337/dc15-2336

7. Way KL, Hackett DA, Baker MK, Johnson NA. The Effect of Regular Exercise on Insulin Sensitivity in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Diabetes Metab J. 2016;40(4):253-71. DOI: https://doi.org/10.4093/dmj.2016.40.4.253

8. Kim DY, Seo BD, Kim DJ. Effect of walking exercise on changes in cardiorespiratory fitness, metabolic syndrome markers, and high-molecular-weight adiponectin in obese middle-aged women. J Phys Ther Sci. 2014;26(11):1723-7. DOI: https://doi.org/10.1589/jpts.26.1723

9. Tokmakidis SP, Touvra AM, Douda HT, Smilios I, Kotsa K, Volaklis KA. Training, detraining, and retraining effects on glycemic control and physical fitness in women with type 2 diabetes. Horm Metab Res. 2014;46(13):974-9. DOI: https://doi.org/10.1055/s-0034-1390483

10. Mendes R, Sousa N, Almeida A, Subtil P, Guedes-Marques F, Reis VM, et al. Exercise prescription for patients with type 2 diabetes-a synthesis of international recommendations: narrative review. Br J Sports Med. 2016;50(22):1379-81. DOI: https://doi.org/10.1136/bjsports-2015-094895

11. Harmer AR, Elkins MR. Amount and frequency of exercise affect glycaemic control more than exercise mode or intensity. Br J Sports Med. 2015;49(15):1012-4. DOI: https://doi.org/10.1136/bjsports-2013-093225

12. Mangiamarchi P, Caniuqueo A, Ramírez-Campillo R, Cárdenas P, Morales S, Cano-Montoya J, et al. Ejercicio intermitente y consejería nutricional mejoran control glicémico y calidad de vida en pacientes con diabetes mellitus tipo 2. Rev Med Chile. 2017;145(7):845-53. DOI: http://dx.doi.org/10.4067/s0034-98872017000700845

13. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352(9131):837-53.

14. Skyler JS, Bergenstal R, Bonow RO, Buse J, Deedwania P, Gale EA, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VADT diabetes trials: a position statement of the American Diabetes Association and a scientific statement of the American College of Cardiology Foundation and the American Heart Association. Diabetes Care. 2009;32(1):187-92. DOI: https://doi.org/10.2337/dc08-9026

15. ACCORD Study Group, Cushman WC, Evans GW, Byington RP, Goff DC Jr, Grimm RH Jr, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362(17):1575-85. DOI: https://doi.org/10.1056/nejmoa1001286

16. American Diabetes Association. 9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Supl 1):S86-104. DOI: https://doi.org/10.2337/dc18-s009

17. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation [Internet]. 2019 [citado 11 Oct 2020];140(11):e596-e646. Disponible en: https://doi.org/10.1161/cir.0000000000000678

18. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Pharmacologic Management of Type 2 Diabetes: 2016 Interim Update. Can J Diabetes. 2016;40(6):484-6. DOI: https://doi.org/10.1016/j.jcjd.2016.09.003

19. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee, Harper W, Clement M, Goldenberg R, Hanna A, Main A, et al. Pharmacologic management of type 2 diabetes. Can J Diabetes. 2013;37 (Suppl 1):S61-8. DOI: https://doi.org/10.1016/j.jcjd.2013.01.021

20. Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, et al. Diabetes Medications as Monotherapy or Metformin-Based Combination Therapy for Type 2 Diabetes: A Systematic Review and Meta-analysis. Ann Intern Med. 2016;164(11):740-51. DOI: https://doi.org/10.7326/m15-2650

21. Griffin SJ, Leaver JK, Irving GJ. Impact of metformin on cardiovascular disease: a meta-analysis of randomised trials among people with type 2 diabetes. Diabetologia. 2017;60(9):1620-9. DOI: https://doi.org/10.1007/s00125-017-4337-9

22. Drug Safety and Availability. FDA Drug Safety Communication: FDA revises warnings regarding use of the diabetes medicine metformin in certain patients with reduced kidney function. Drug [Internet]. 2017 [citado 15 Oct 2020]. Disponible en: https://www.fda.gov/Drugs/DrugSafety/ucm493244.htm

23. Davies MJ, D'Alessio DA, Fradkin J, Kernan WN, Mathieu C, Mingrone G, et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018;41(12):2669-701. DOI: https://doi.org/10.2337/dci18-0033

24. Vaccaro O, Masulli M, Nicolucci A, Bonora E, Del Prato S, Maggioni AP, et al. Effects on the incidence of cardiovascular events of the addition of pioglitazone versus sulfonylureas in patients with type 2 diabetes inadequately controlled with metformin (TOSCA.IT): a randomised, multicentre trial. Lancet Diabetes Endocrinol. 2017;5(11):887-97. DOI: https://doi.org/10.1016/s2213-8587(17)30317-0

25. Khera R, Murad MH, Chandar AK, Dulai PS, Wang Z, Prokop LJ, et al. Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA. 2016;315(22):2424-34. DOI: https://doi.org/10.1001/jama.2016.7602

26. Neal B, Perkovic V, Matthews DR. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med. 2017;377(21):2097-9. DOI: https://doi.org/10.1056/nejmc1712572

27. Zinman B, Lachin JM, Inzucchi SE. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2016;374(11):1092-4. DOI: https://doi.org/10.1056/nejmc1600827

28. Novo Nordisk. Semaglutide receives positive 16-0 vote in favour of approval from FDA Advisory Committee [Internet]. 2017. Disponible en: https://www.reuters.com/article/brief-novo-nordisk-says-semaglutide-rece/brief-novo-nordisk-says-semaglutide-receives-positive-16-0-vote-in-favour-of-approval-from-fda-advisory-committee-idINFWN1MT0TA

29. Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, et al. Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377:1228-39. DOI: https://doi.org/10.1056/NEJMoa1612917

30. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jódar E, Leiter LA, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2016;375(19):1834-44. DOI: https://doi.org/10.1056/nejmoa1607141

31. Pfeffer MA, Claggett B, Diaz R, Dickstein K, Gerstein HC, Køber LV, et al. Lixisenatide in Patients with Type 2 Diabetes and Acute Coronary Syndrome. N Engl J Med. 2015;373(23):2247-57. DOI: https://doi.org/10.1056/nejmoa1509225

32. Fitchett D, Butler J, van de Borne P, Zinman B, Lachin JM, Wanner C, et al. Effects of empagliflozin on risk for cardiovascular death and heart failure hospitalization across the spectrum of heart failure risk in the EMPA-REG OUTCOME® trial. Eur Heart J. 2018;39(5):363-70. DOI: https://doi.org/10.1093/eurheartj/ehx511

33. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375(4):311-22. DOI: https://doi.org/10.1056/nejmoa1603827

34. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369(14):1317-26. DOI: https://doi.org/10.1056/nejmoa1307684

35. White WB, Cannon CP, Heller SR, Nissen SE, Bergenstal RM, Bakris GL, et al. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013;369(14):1327-35. DOI: https://doi.org/10.1056/nejmoa1305889

36. Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, et al. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2015;373(3):232-42. DOI: https://doi.org/10.1056/nejmoa1501352

37. McMurray JJV, Ponikowski P, Bolli GB, Lukashevich V, Kozlovski P, Kothny W, et al. Effects of Vildagliptin on Ventricular Function in Patients With Type 2 Diabetes Mellitus and Heart Failure: A Randomized Placebo-Controlled Trial. JACC Heart Fail. 2018;6(1):8-17. DOI: https://doi.org/10.1016/j.jchf.2017.08.004

38. Moura CS, Rosenberg ZB, Abrahamowicz M, Bernatsky S, Behlouli H, Pilote L. Treatment Discontinuation and Clinical Events in Type 2 Diabetes Patients Treated with Dipeptidyl Peptidase-4 Inhibitors or NPH Insulin as Third-Line Therapy. J Diabetes Res [Internet]. 2018 [citado 20 Oct 2020];2018:4817178. Disponible en: https://doi.org/10.1155/2018/4817178

39. McMurray JJV, Ponikowski P, Bolli GB, Lukashevich V, Kozlovski P, Kothny W, et al. Effects of Vildagliptin on Ventricular Function in Patients With Type 2 Diabetes Mellitus and Heart Failure: A Randomized Placebo-Controlled Trial. JACC Heart Fail. 2018;6(1):8-17. DOI: https://doi.org/10.1016/j.jchf.2017.08.004

40. Lincoff AM, Wolski K, Nicholls SJ, Nissen SE. Pioglitazone and risk of cardiovascular events in patients with type 2 diabetes mellitus: a meta-analysis of randomized trials. JAMA. 2007;298(10):1180-8. DOI: https://doi.org/10.1001/jama.298.10.1180

41. Singh S, Loke YK, Furberg CD. Long-term risk of cardiovascular events with rosiglitazone: a meta-analysis. JAMA. 2007;298(10):1189-95. DOI: https://doi.org/10.1001/jama.298.10.1189

42. American College of Cardiology. Effect of Ranolazine in Type 2 Diabetes: Evaluation of Its Use Beyond Chronic Stable Angina. [Internet] 2017. [citado 23 Oct 2020] Disponible en: https://www.acc.org/latest-in-cardiology/articles/2017/06/01/16/10/effect-of-ranolazine-in-type-2-diabetes

43. Brown RA. Rehabilitation of patients with cardiovascular diseases. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1964;270:3-46.

44. López Jiménez F, Pérez-Terzic C, Zeballos PC, Anchique CV, Burdiat G, González K, et al. Consenso de RCV y Prevención Secundaria de las Sociedades Interamericana y Sudamericana de Cardiología. Rev Urug Cardiol. 2013;28(2):189-224.

45. Acevedo M, Kramer V, Bustamante MJ, Yáñez F, Guidi D, Corbalán R, et al. Rehabilitación cardiovascular y ejercicio en prevención secundaria. Rev Med Chile. 2013;141(10):1307-14. DOI: http://dx.doi.org/10.4067/S0034-98872013001000010

46. Sociedad Argentina de Cardiología. Consenso Argentino de Rehabilitación Cardiovascular. Rev Arg Card. 2019;87(3):1-57.

47. Schwingshackl L, Missbach B, Dias S, König J, Hoffmann G. Impact of different training modalities on glycaemic control and blood lipids in patients with type 2 diabetes: a systematic review and network meta-analysis. Diabetologia. 2014;57(9):1789-97. DOI: https://doi.org/10.1007/s00125-014-3303-z

48. Liu Y, Liu SX, Cai Y, Xie KL, Zhang WL, Zheng F. Effects of combined aerobic and resistance training on the glycolipid metabolism and inflammation levels in type 2 diabetes mellitus. J Phys Ther Sci. 2015;27(7):2365-71. DOI: https://doi.org/10.1589/jpts.27.2365

49. Mendham AE, Duffield R, Marino F, Coutts AJ. A 12-week sports-based exercise programme for inactive Indigenous Australian men improved clinical risk factors associated with type 2 diabetes mellitus. J Sci Med Sport. 2015;18(4):438-43. DOI: https://doi.org/10.1016/j.jsams.2014.06.013

50. Little JP, Gillen JB, Percival ME, Safdar A, Tarnopolsky MA, Punthakee Z, et al. Low-volume high-intensity interval training reduces hyperglycemia and increases muscle mitochondrial capacity in patients with type 2 diabetes. J Appl Physiol (1985). 2011;111(6):1554-60. DOI: https://doi.org/10.1152/japplphysiol.00921.2011

51. Alvarez C, Ramirez-Campillo R, Martinez-Salazar C, Mancilla R, Flores-Opazo M, Cano-Montoya J, et al. Low-Volume High-Intensity Interval Training as a Therapy for Type 2 Diabetes. Int J Sports Med. 2016;37(9):723-9. DOI: https://doi.org/10.1055/s-0042-104935

52. Mancilla R, Torres P, Álvarez C, Schifferli I, Sapunar J, Díaz E. High intensity interval training improves glycemic control and aerobic capacity in glucose intolerant patients. Rev Med Chil. 2014;142(1):34-9. DOI: https://doi.org/10.4067/s0034-98872014000100006

53. Golbidi S, Badran M, Laher I. Antioxidant and anti-inflammatory effects of exercise in diabetic patients. Exp Diabetes Res [Internet]. 2012 [citado 28 Oct 2020];2012:941868. Disponible en: https://doi.org/10.1155/2012/941868

54. Verma S, Moiz JA, Anwer S, Alghadir AH, Hussain ME. A dose-response study of aerobic training for oxygen uptake, oxidative stress and cardiac autonomic function in type 2 diabetes mellitus: study protocol for a randomized controlled trial. Trials [Internet]. 2018 [citado 28 Oct 2020];19(1):289. Disponible en: https://doi.org/10.1186/s13063-018-2671-y

55. Nishitani M, Shimada K, Sunayama S, Masaki Y, Kume A, Fukao K, et al. Impact of diabetes on muscle mass, muscle strength, and exercise tolerance in patients after coronary artery bypass grafting. J Cardiol. 2011;58(2):173-80. DOI: https://doi.org/10.1016/j.jjcc.2011.05.001

56. Huebschmann AG, Kohrt WM, Herlache L, Wolfe P, Daugherty S, Reusch JE, et al. Type 2 diabetes exaggerates exercise effort and impairs exercise performance in older women. BMJ Open Diabetes Res Care [Internet]. 2015 [citado 29 Oct 2020];3(1):e000124. Disponible en: https://doi.org/10.1136/bmjdrc-2015-000124

57. Innes KE, Selfe TK. Yoga for Adults with Type 2 Diabetes: A Systematic Review of Controlled Trials. J Diabetes Res [Internet]. 2016 [citado 29 Oct 2020];2016:6979370. Disponible en: https://doi.org/10.1155/2016/6979370

58. Ahn S, Song R. Effects of Tai Chi Exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy. J Altern Complement Med. 2012;18(12):1172-8. DOI: https://doi.org/10.1089/acm.2011.0690

59. Jiménez-Navarro MF, Lopez-Jimenez F, Pérez-Belmonte LM, Lennon RJ, Diaz-Melean C, Rodriguez-Escudero JP, et al. Benefits of Cardiac Rehabilitation on Cardiovascular Outcomes in Patients With Diabetes Mellitus After Percutaneous Coronary Intervention. J Am Heart Assoc [Internet]. 2017 [citado 1 Nov 2020];6(10):e006404. Disponible en: https://doi.org/10.1161/jaha.117.006404

60. Choe Y, Han JY, Choi IS, Park HK. Improvement of exercise capacity in patients with type 2 diabetes mellitus during cardiac rehabilitation. Eur J Phys Rehabil Med. 2018;54(6):981-3. DOI: https://doi.org/10.23736/s1973-9087.18.05250-4

61. Toste S, Viamonte S, Barreira A, Fernandes P, Lopes Gomes J, Torres S. Cardiac rehabilitation in patients with type 2 diabetes mellitus and coronary disease: a comparative study. Rev Port Cardiol. 2014;33(10):599-608. DOI: https://doi.org/10.1016/j.repc.2014.01.026

62. St Clair M, Mehta H, Sacrinty M, Johnson D, Robinson K. Effects of cardiac rehabilitation in diabetic patients: both cardiac and noncardiac factors determine improvement in exercise capacity. Clin Cardiol. 2014;37(4):233-8. DOI: https://doi.org/10.1002/clc.22245

63. Aguiar EJ, Morgan PJ, Collins CE, Plotnikoff RC, Callister R. Efficacy of interventions that include diet, aerobic and resistance training components for type 2 diabetes prevention: a systematic review with meta-analysis. Int J Behav Nutr Phys Act [Internet]. 2014 [citado 2 Nov 2020];11:2. Disponible en: https://doi.org/10.1186/1479-5868-11-2

64. Gómez-González A, Calderín GM, Pleguezuelos Cobos E, Expósito Tirado JA, Heredia Torres A, Montiel Trujillo, et al. Recomendaciones sobre rehabilitación cardíaca en la cardiopatía isquémica de la Sociedad de Rehabilitación Cardio-Respiratoria (SORECAR). Rehabilitación (Madr). 2015;49(2):102-24. DOI: http://dx.doi.org/10.1016/j.rh.2014.12.002

65. Lopez-Jimenez F, Kramer VC, Masters B, Stuart PM, Mullooly C, Hinshaw L, et al. Recommendations for managing patients with diabetes mellitus in cardiopulmonary rehabilitation: an American Association of Cardiovascular and Pulmonary Rehabilitation statement. J Cardiopulm Rehabil Prev. 2012;32(2):101-12. DOI: https://doi.org/10.1097/hcr.0b013e31823be0bc

66. Jaureguizar KV, Vicente-Campos D, Bautista LR, de la Peña CH, Gómez MJ, Rueda MJ, et al. Effect of High-Intensity Interval Versus Continuous Exercise Training on Functional Capacity and Quality of Life in Patients With Coronary Artery Disease: A RANDOMIZED CLINICAL TRIAL. J Cardiopulm Rehabil Prev. 2016;36(2):96-105. DOI: https://doi.org/10.1097/hcr.0000000000000156

67. Terada T, Boulé NG, Forhan M, Prado CM, Kenny GP, Prud'homme D, et al. Cardiometabolic risk factors in type 2 diabetes with high fat and low muscle mass: At baseline and in response to exercise. Obesity (Silver Spring). 2017;25(5):881-91. DOI: https://doi.org/10.1002/oby.21808

68. Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-81.

69. Lopez-Jimenez F, Kramer VC, Masters B, Stuart PM, Mullooly C, Hinshaw L, et al. Recommendations for managing patients with diabetes mellitus in cardiopulmonary rehabilitation: an American Association of Cardiovascular and Pulmonary Rehabilitation statement. J Cardiopulm Rehabil Prev. 2012;32(2):101-12. DOI: https://doi.org/10.1097/hcr.0b013e31823be0bc

70. Hollekim-Strand SM, Bjørgaas MR, Albrektsen G, Tjønna AE, Wisløff U, Ingul CB. High-intensity interval exercise effectively improves cardiac function in patients with type 2 diabetes mellitus and diastolic dysfunction: a randomized controlled trial. J Am Coll Cardiol. 2014;64(16):1758-60. DOI: https://doi.org/10.1016/j.jacc.2014.07.971

Descargas

Publicado

2021-07-12

Cómo citar

1.
Pérez Yánez LM, Gutiérrez López A, Rodríguez Blanco S. Diabetes mellitus tipo 2: Consideraciones sobre riesgo y rehabilitación cardiovasculares. Segunda parte. CorSalud [Internet]. 12 de julio de 2021 [citado 24 de junio de 2025];13(3):348-60. Disponible en: https://revcorsalud.sld.cu/index.php/cors/article/view/676

Número

Sección

ARTÍCULO DE REVISIÓN