Sndrome

metablico y
prevencin de DM:
a favor de estilos de vida

TUTOR: DR. ESTRADA GARZONA

PAO L A AG E R O Z A M O RA
MICHELLE MUOZ HERMANN-L
SUSAN ROSALES QUIRS
RA FA E L S A N A B R I A R O D R G U E Z

Criterios diagnsticos el
SM

Obesity, Metabolic Syndrome, and Diabetes: Cardiovascular

Implications and Therapy. Rev. Espaola de Cardiologa; 2008, 61
(7):752-64

1- Modificacin del estilo

de vida: ejercicio y dieta
DIETA

EJERCICIO

Recomendacin
estndar:
- 30 min
- EA
- Intensidad moderada
- > 5 veces /sem

Treatment of the Metabolic Syndrome: The Impact of Lifestyle

Modification. Current Atherosclerosis Reports; 2005, 7:95-102

Modificacin del estilo de

vida: ejercicio y dieta

Treatment of the Metabolic Syndrome: The Impact of Lifestyle

Modification. Current Atherosclerosis Reports; 2005, 7:95-102

- Tejido adiposo
visceral
- GH, Liplisis
- PAI-1
-LDL
-HDL
-TG

- IL-6
- IL-18
- TNF
- PCR

-Sal
-1x1
-Hipertenso
s

- HTA

-PPD
-Diagnostica
dos

2- Otros factores que

contribuyen con el SM
SUEO:
ALCOHOL:
DROGAS:
ESTRS:
TABACO:

3- Utilizacin de frmacos
No hay datos sobre beneficio sostenido en el tiempo
No datos de que su uso a largo plazo prevenga DM y/o
ECV
Efectos Adversos de frmacos
Costo/Efectividad vs. Ejercicio
Slo 4/10 cumple con tx HO
Tx de sx o de causa?

Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review
and mixed treatment comparison meta-analysis, 2012
INERTIA study: Clinical inertia in non-insulinized patients on oral hypoglycemic treatment. A study in Spanish primary and specialty care

Muchas Gracias!

Referencias bibliogrficas
[1]: Alegra E, Castellano JM, Alegra A. Obesity, Metabolic Syndrome, and Diabetes: Cardiovascular Implications
and Therapy. Rev. Espaola de Cardiologa; 2008, 61 (7):752-64.
[2]: Day C. Metabolic syndrome, or What you will: definitions and epidemiology. Diab Vasc Dis Res; 2007, 4:32
8.
[3]: Pritchett A, Foreyt J, Mann D. Treatment of the Metabolic Syndrome: The Impact of Lifestyle Modification.
Current Atherosclerosis Reports; 2005, 7:95-102.
[4]: Kastorini CM, Milionis HJ, Esposito K, et al. The effect of Mediterranean diet on metabolic syndrome and its
components. J Am Coll Cardiol; 2011, 57: 1299313.
[5]: Bateman L, Slentz C, Willis L, Shields A, Piner L, Bales C, Houmard J, Kraus W. Comparison of Aerobic Versus
Resistance Exercise Training Effects on Metabolic Syndrome (from the Studies of a Targeted Risk Reduction
Intervention Through Defined Exercise - STRRIDE-AT/RT). The American Journal of Cardiology; 2011,108 (6): 83844.
[6]:Stanley T, Grinspoon S. Effects of growth hormonereleasing hormone on visceral fat, metabolic, and
cardiovascular indices in human studies. Growth Hormone & IGF Research; 2015, 25 (2): 59-65.
[7]: Thompson P, Buchner D, Pina I, et al. Exercise and physical activity in the prevention and treatment of
atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on
Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism
(Subcommittee on Physical Activity). American College of Sports Medicine; 2003, 107: 310916.
[8]: The Diabetes Prevention Program Research Group. Impact of Intensive Lifestyle and Metformin Therapy on
Cardiovascular Disease Risk Factors in the Diabetes Prevention Program.Diabetes Care; 2005, 28(4): 88894.
[9]: Chang A, Van Horn L, et al. Lifestyle-Related Factors, Obesity, and Incident Microalbuminuria: The CARDIA
(Coronary Artery Risk Development in Young Adults) Study. American Journal of Kidney Diseases; 2013, 62 (2):
267-75.
[10]: Rodilla E, Costa J, Mares S, et al. Importancia de los componentes del sndrome metablico en los valores
de protena C reactiva. Revista Clnica Espaola; 2006, 206 (8): 363-8.[

Referencias bibliogrficas
[11]: Kumar A, Jain A, et al. Imbalance between protective (adiponectin) and prothrombotic (Plasminogen
Activator Inhibitor-1) adipokines in metabolic sndrome. Diabetes & Metabolic Syndrome: Clinical Research &
Reviews; 2014, 8 (3):152-5.
[12]: Wong P, Manuck S, DiNardo M, Korytkowski M, Muldoon M.Shorter sleep duration is associated with
decreased insulin sensitivity in Healthy White Men. Sleep; 2015, 38 (2): 223-31.
[13]: Mesarwi O, Sharma E, Jun J, et al. Metabolicdysfunction in obstructive sleep apnea: A critical
examination of underlying mechanisms. Sleep and biological rhythms;2015,13(1):2-17.
[14]: Thatcher M, Tippetts T, Nelson M, et al. Ceramides mediate cigarette smoke-induced metabolic
disruption in mice. American journal of physiology-Endocrinology and Metabolism; 2014, 307 (10): 919-27.
[15]: Tyagi A, Cohen M, Reece J, Telles S. An exploratory study of metabolic stress practices and mental
yoga, yoga practitioners responses, non-yoga practitioners and people with metabolic syndrome. MC
Complementary and Alternative Medicine; 2014, 14: 445.
[16]: Mikus C, et al. Simvastatin Impairs Excercise Training Adaptations. Journal of the American College of
Cardiology; 2013, 62(8).
[17]: Cho Y, et al. Ris of diabetes in patients treated with HMG-CoA reductase inhibitors. Metabolism Clinical
and Experimental; 2015, 64: 482-8
[18]: Vives M, Romano J, Stoll E, Lafuente A, Nagore D, Monedero P. Acidosis lctica asociada a metformina:
inidencia, diagnstico, factores pronstico y tratamiento. Rev Esp Anestesiol Reanim; 2012, 59(5): 276-9
[19]: Masmiquel L. Efecto cardiovasculares y seguridad de los frmacos hipogluceiantes: situacin actual.
Semergen; 2014, 2: 80-8.

Meta anlisis
Once intervenciones en ocho ECA fueron utilizados para los
metanlisis.
La proporcin relativa de los pacientes con SM resueltos en el grupo
de intervencin fue de aproximadamente 2 veces mayor en el grupo
de intervencin en comparacin con el grupo control.
LMI redujo significativamente los valores medios de:
- PAS por -6,4 mmHg (IC del 95%: -9,7 a -3,2)
- PAD por -3,3 mmHg (95% IC -5,2 a -1,4)
- Triglicridos de -12,0 mg / dl (95% IC -22,2 a -1,7)
- Circunferencia abdominal -2,7 cm (95% IC -4,6 a -0,9)
- Glucemia en ayunas por -11,5 mg / dl (95% IC -22,4 a -0,6)
- Las reducciones no fueron significativas para HDL (1,3mg/dl; IC 95%:
-0,6 a 3,1)

Metformina
Indicacin:
-

Ayudante a la dieta y ejercicio para mejorar control

glicmico en DM2

Efectos secundarios:

- GI: Diarrea llev a abandonar tx en 6%

Advertencia:
- Riesgo de acidosis lctica mortalidad 30-50%
- Metformina + Sulfonilureas riesgo de
mortalidad asociada a DM2

Risk of diabetes in patients treated with HMG-CoA reductase

inhibitors, 2015
Metformin http://www.accessdata.fda.gov/

Estatinas
Posibilidad de desarrollar DM
EA: mialgias, rabdomiolsis, susceptibilidad a dao mm en ejercicio

Risk of diabetes in patients treated with HMG-CoA reductase

inhibitors, 2015

Efectos Adversos de otros frmacos

Efectos cardiovasculares y seguridad de los frmacos hipoglucemiantes:

situacin actual, 2013

Estatinas: Simvastatina

Simvastatin Impairs Exercise Training

Efectos Ejercicio vs.

Metformina

Independent and Combined Effects of Exercise Training andMetformin on Insulin Sensitivity in Individuals With Prediabetes,
Diabetes care vol 35, jan 2012

Long-Term Benefits From Lifestyle Interventions for Type 2 Diabetes Prevention. Diabetes
Care, vol 34, 2011

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin, N engl J med, vol.

Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin, N Engl J Med, Vol. 346,
No. 6 February 7, 2002