Estadísticas

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        "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Una mujer de 62 a&#241;os con obesidad&#44; hipertensi&#243;n arterial y diabetes mellitus tipo 2 es remitida a una unidad de riesgo vascular del servicio de medicina interna porque su HbA<span class="elsevierStyleInf">1c</span> est&#225; elevada &#40;8&#44;1&#37;&#41; a pesar de tomar regularmente metformina &#40;850<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41; y glipizida &#40;10<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41;&#46; Trata de hacer ejercicio cada d&#237;a &#40;caminar 30<span class="elsevierStyleHsp" style=""></span>min&#41; y ha adelgazado &#40;de 5 a 12<span class="elsevierStyleHsp" style=""></span>kg&#41; en varias ocasiones&#44; pero siempre ha vuelto a ganar lo perdido&#46; Adem&#225;s se controla su glucemia en ayunas cada dos semanas y suele tener entre 120 y 160<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; Su hipertensi&#243;n arterial est&#225; siendo tratada con enalapril&#47;hidroclorotiazida y adem&#225;s toma aspirina &#40;100<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; y simvastatina &#40;20<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#46; En su historia familiar se recoge que un hermano falleci&#243; s&#250;bitamente a los 50 a&#241;os&#46; En la exploraci&#243;n f&#237;sica presenta un IMC de 32&#44;4<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span> y no tiene edemas en los miembros inferiores&#46; Su PA es de 154&#47;82<span class="elsevierStyleHsp" style=""></span>mmHg y la creatinina de 0&#44;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#46; No presenta microalbuminuria y su funci&#243;n hep&#225;tica es normal&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">&#191;Qu&#233; tratamiento le parece a Vd&#46; m&#225;s indicado&#63;</p><p class="elsevierStyleSimplePara elsevierViewall">1&#46; A&#241;adir glitazonas&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">2&#46; A&#241;adir incret&#237;n mim&#233;ticos &#40;glucagon like peptide 1 &#91;GLP1&#93;&#47;inhibidores de la dipeptidilpeptidasa 4 &#91;DPP-4&#93;&#41;&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">3&#46; A&#241;adir insulina de acci&#243;n lenta&#46;</p>"
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        "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">A 62-year old woman with obesity&#44; high blood pressure and type 2 diabetes mellitus &#40;DM2&#41; was referred to a Vascular Risk Unit of the Internal Medicine Department due to elevated HbA1C &#40;8&#46;1&#37;&#41; in spite of having taken metformin &#40;850<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41; and glipizide &#40;10<span class="elsevierStyleHsp" style=""></span>mg&#47;12<span class="elsevierStyleHsp" style=""></span>h&#41; regularly&#46; She tries to exercise daily &#40;walking 30<span class="elsevierStyleHsp" style=""></span>min&#41; and has lost weight &#40;from 5 to 12<span class="elsevierStyleHsp" style=""></span>kg&#41; several times&#44; but always regains what she has lost&#46; Furthermore&#44; she monitors her glucose levels in fasting every two weeks and generally has between 120 and 160<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Her high blood pressure is being treated with enalapril&#47;HCTZ and she also takes aspirin 100<span class="elsevierStyleHsp" style=""></span>mg&#47;day and simvastatin 20<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#46; It is seen in her family background that one brother died suddenly at 50 years of age&#46; Her physical examination shows a BMI of 32&#46;4<span class="elsevierStyleHsp" style=""></span>Kg&#47;m<span class="elsevierStyleSup">2</span>&#44; and she has no edemas in the lower limbs&#46; Her BP is 154&#47;82<span class="elsevierStyleHsp" style=""></span>mmHg and creatinine 0&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; She has no microalbuminuria and her liver function is normal&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">What treatment do you think would be the more appropriate&#63;</p><p class="elsevierStyleSimplePara elsevierViewall">1 - Add glitazones&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">2 - Add incretin mimetics &#40;GLP 1&#47; DPP-4&#41;&#46;</p><p class="elsevierStyleSimplePara elsevierViewall">3 - Slow acting insulin&#46;</p>"
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