Guia de práctica clinica para el tratamiento de la diabetes mellitus tipo 2: Manejo inicial

Introduction: Today, metformin is widely accepted as
standard initial pharmacologic treatment for diabetes
mellitus type 2 (DMT2). However, it is controversial if in
some groups of patients, the treatment can be initiated
only with life style changes, or if there are groups who
should begin with combined therapy since the beginning.
Aim: To define the effect of intensive strategies for
change of diet or exercise, and the effect of combined
therapy with metformin and a second oral antidiabetic, as
initial treatment in patients with newly DMT2. Methods:
A clinical practice guide has been developed following
the broad outline of the methodological guide from the
Colombian Ministry of Health and Social Welfare. with
the aim of systematically gathering scientific evidence
and formulating recommendations using the GRADE
(Grading of Recommendations Assessment, Development
and Evaluation) methodology. Conclusions: In patients
with recently diagnosed DMT2, initial treatment with
lifestyle changes only is not recommended. However,
it is recommended that lifestyles changes must begin
simultaneously with metformin, including the components
of a Mediterranean diet and aerobic exercise. In patients
with recently diagnosed DMT2 and HbA1c levels
>8%, it is recommended to administer a combined
therapy from the beginning with metformin and another
oral antidiabetic medication. The DPP4 inhibitor is
recommended.