Resumen de Evaluación de la eficacia y seguridad de un protocolo de manejo de pacientes con diabetes descompensada por glucocorticoides durante la hospitalización

Ana Agudo Tabuenca

• Introducción: En el medio intrahospitalario hay una muy elevada prevalencia de descompensaciones hiperglucémicas en pacientes con diagnóstico de diabetes mellitus secundarias a tratamiento corticoideo. Sin embargo, no existen protocolos consensuados de manejo hospitalario de las descompensaciones hiperglucémicas inducidas por dosis farmacológicas de glucocorticoides (GC). El objetivo de la presente tesis fue evaluar la eficacia y seguridad de un protocolo de insulinización específico para corticoides (PC) frente a un protocolo general (PG) ya instaurado en el hospital en diabetes descompensada por GC (DDG).

  Materiales y métodos: Fue un estudio experimental con grupo control, no aleatorizado, en pacientes con diabetes descompensada por glucocorticoides ingresados en neumología. Se recogieron variables demográficas, antropométricas, analíticas y clínicas, y diariamente se recogieron datos de glucemias capilares basales, prepandriales y la realizada a las doce de la noche. Se compararon 2 protocolos (protocolo corticoides y protocolo general), ambos basados en terapia basal-bolo pero con diferentes dosis y distribución de insulina.

  Se evaluó la diferencia de glucemia media (GM) durante la hospitalización entre el protocolo corticoides y el protocolo general, así como el riesgo de presentar una glucemia media superior a 200 mg/dl, ajustado para potenciales factores de confusión (relacionados con el paciente y con la terapia de glucocorticoides empleada).

  Resultados: Se incluyeron 131 pacientes, 60 asignados al protocolo general y 71 al protocolo corticoides. Un 74% de los pacientes estaban ingresados por exacerbación de enfermedad pulmonar obstructiva crónica. Hubo diferencia significativa en la dosis total de insulina entre el protocolo general y el protocolo corticoides (29,4 vs 57,4 unidades; p<0,0001).

  La diferencia ajustada de glucemia media (PC-PG) fue de -14,8 (IC 95% de -26,2 a -3,3) mg/dl. Los pacientes del protocolo corticoides tuvieron menor riesgo ajustado de presentar una glucemia media superior a 200 mg/dl durante la hospitalización (OR=0,31; IC 95% 0,11-0,91; p=0,033). No hubo diferencias en el riesgo de hipoglucemia grave entre el protocolo general y el protocolo corticoides (0% vs 1,4%; p=0,36).

  Conclusiones: El protocolo estudiado ha demostrado reducir la glucemia media de pacientes con diabetes descompensada por glucocorticoides durante la hospitalización sin comprometer su seguridad en cuanto a hipoglucemias, complicaciones intrahospitalarias y mortalidad se refiere..

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