[Recommendations of the main clinical practice guidelines]. / Recomendaciones de las principales guías de práctica clínica.

The development of new drugs to treat hyperglycemia in persons with type 2 diabetes mellitus and recent cardiovascular safety studies of these new molecules have created the need to update the various clinical practice guidelines and consensus documents on the approach and treatment of this highly prevalent disease. Metformin continues to be the first-line drug. Dipeptidyl peptidase-4 inhibitors are oral lipid-lowering drugs with specific characteristics favouring their use in primary care. Among other characteristics, these drugs have few drug-drug interactions, can be easily combined with other drugs, are well tolerated, have a neutral effect on weight, and have a low risk of producing hypoglycaemic episodes, all of which encourages their prescrip-tion. Dipeptidyl peptidase-4 inhibitors are considered as second-line drugs (and as first-line drugs if metformin is contraindicated or poorly tolerated). In some specific situa-tions, this position could be threatened by the development of new drug families, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 analogues, which have shown benefits in reducing major cardiovascular events and mortality. It is important to determine the current place of dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes mellitus, since they have been increasingly prescribed in primary care in the last few years.

Recomendaciones de las principales guías de práctica clínica / Recommendations of the main clinical practice guidelines

La aparición de nuevos fármacos para tratar la hiperglucemia en las personas con diabetes mellitus tipo 2 y los recientes estudios de seguridad cardiovascular de estas nuevas moléculas, conllevan la necesidad de actualización de las diferentes guías de práctica clínica y documentos de consenso sobre el abordaje y tratamiento de esta patología tan prevalente. En cuanto al tratamiento, metformina sigue siendo el fármaco de primera elección. Los fármacos inhibidores de la dipeptidil peptidasa 4 son fármacos antihiperglucemiantes orales con unas determinadas características que favorecen su uso en atención primaria. Entre otros aspectos, su bajo perfl de interacciones medicamentosas, el ser fácilmente combinables, la buena tolerancia, el efecto neutro sobre el peso y el bajo riesgo de hipo-glucemias, conducen a cierta comodidad de prescripción. Se han considerado los fármacos de elección en segundo escalón (y en primer escalón si está contraindicada o no se tolera la metformina) y podrían ver amenazada esta posición, en algunas situaciones concretas, con la aparición de nuevas familias de fármacos, como los inhibidores del cotrans-portador de sodio y glucosa y los análogos del receptor del péptido similar al glucagón tipo 1, algunas moléculas de las cuales han demostrado benefcios en la reducción de episodios cardiovasculares mayores y mortalidad. Es importante conocer el posicionamiento actual de los fármacos inhibidores de la dipep-tidil peptidasa 4 respecto al abordaje y tratamiento de la diabetes mellitus tipo 2, ya que han experimentado un aumento en la prescripción en atención primaria en los últimos años. (C) 2018 SEMERGEN. Publicado por Elsevier España, S.L.U. Todos los derechos reservados

The development of new drugs to treat hyperglycemia in persons with type 2 diabetes mellitus and recent cardiovascular safety studies of these new molecules have created the need to update the various clinical practice guidelines and consensus documents on the approach and treatment of this highly prevalent disease. Metformin continues to be the first-line drug. Dipeptidyl peptidase-4 inhibitors are oral lipid-lowering drugs with specific characteristics favouring their use in primary care. Among other characteristics, these drugs have few drug-drug interactions, can be easily combined with other drugs, are well tolerated, have a neutral effect on weight, and have a low risk of producing hypoglycaemic episodes, all of which encourages their prescrip-tion. Dipeptidyl peptidase-4 inhibitors are considered as second-line drugs (and as first-line drugs if metformin is contraindicated or poorly tolerated). In some specific situa-tions, this position could be threatened by the development of new drug families, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 analogues, which have shown benefits in reducing major cardiovascular events and mortality. It is important to determine the current place of dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes mellitus, since they have been increasingly prescribed in primary care in the last few years