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Eventos adversos asociados al inicio de iSGLT2 en pacientes adultos hospitalizados: una revisión de alcance

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dc.contributor.advisorOspina Medina, María Cristina
dc.creatorMerchán Paipa, Jorge David
dc.creatorMulett Torres, Lia Rosa
dc.creatorBurgos Caro, Daniel Alejandro
dc.creator.degreeEspecialista en Epidemiología (en Convenio con el CES)
dc.creator.degreeLevelEspecialización
dc.creator.degreetypeFull time
dc.date.accessioned2024-07-17T01:08:25Z
dc.date.available2024-07-17T01:08:25Z
dc.date.created2024-07-02
dc.descriptionIntroducción: Los iSGLT2 son medicamentos hipoglicemiantes utilizados en el tratamiento de la diabetes mellitus tipo 2, falla cardiaca aguda, enfermedad renal crónica y enfermedad coronaria. Su uso en el entorno ambulatorio ha permitido identificar diferentes eventos adversos. No obstante, la evidencia sobre su seguridad en pacientes hospitalizados es limitada. Objetivos: Describir la frecuencia de presentación de eventos adversos asociados al inicio de iSGLT2 por cualquier indicación en pacientes adultos hospitalizados. Metodología: Revisión de alcance que sintetiza la evidencia sobre eventos adversos de iSGLT2 en adultos hospitalizados. Resultados: Los metaanálisis revisados no mostraron diferencias en eventos adversos renales y urinarios entre los iSGLT2 y la insulina (p = 0,293). No se incrementó el riesgo de lesión renal aguda (OR 0.76; IC 95% [0.50, 1.16]), hipotensión (OR 1.17; IC 95% [0.80, 1.71]) ni hipoglucemia (OR 1.51; IC 95% [0.86, 2.65]). Ensayos clínicos mostraron que los iSGLT2 eran seguros y eficaces, sin diferencias en seguridad entre el grupo de intervención y placebo. Un estudio observacional evidenció que la incidencia de lesión renal aguda en pacientes hospitalizados tratados con iSGTL2 fue significativamente menor (p = 0,031), no obstante, un segundo estudio observacional multicéntrico describió 14 casos de cetoacidosis diabética asociadas al uso de iSGLT2. En los reportes de caso documentados se evidencia el desarrollo de cetoacidosis diabética tras la realización de procedimientos quirúrgicos y/o ayuno prolongado. Discusión: Aunque algunos ensayos clínicos y metaanálisis sugieren que el uso intrahospitalario de iSGLT2 es generalmente seguro, reportes y estudios observacionales resaltan riesgos como la cetoacidosis euglucémica en ayuno prolongado y cirugía. Es esencial un monitoreo riguroso y evaluación individualizada en pacientes hospitalizados. Futuros estudios deben enfocarse en la seguridad y eficacia de iSGLT2 en este grupo, así como en estrategias para mitigar los riesgos asociados.
dc.description.abstractIntroduction: iSGLT2 are hypoglycemic medications used in the treatment of type 2 diabetes mellitus, acute heart failure, chronic kidney disease, and coronary artery disease. Their use in outpatient settings has allowed for the identification of various adverse events. However, evidence on their safety in hospitalized patients is limited. Objectives: To describe the frequency of adverse events associated with the initiation of iSGLT2 for any indication in hospitalized adult patients. Methodology: A scoping review that synthesizes the evidence on adverse events of iSGLT2 in hospitalized adults. Results: The reviewed meta-analyses showed no differences in renal and urinary adverse events between iSGLT2 and insulin (p = 0.293). The use of iSGLT2 did not increase the risk of acute kidney injury (OR 0.76; 95% CI [0.50, 1.16]), hypotension (OR 1.17; 95% CI [0.80, 1.71]), or hypoglycemia (OR 1.51; 95% CI [0.86, 2.65]). Clinical trials showed that iSGLT2 were safe and effective, with no differences in safety outcomes between the intervention and placebo groups. An observational study showed that the incidence of acute kidney injury in hospitalized patients treated with iSGLT2 was significantly lower (p = 0.031); however, a second multicenter observational study described 14 cases of diabetic ketoacidosis associated with iSGLT2 use. Case reports documented the development of diabetic ketoacidosis following surgical procedures and/or prolonged fasting. Discussion: Although some clinical trials and meta-analyses suggest that the inpatient use of iSGLT2 is generally safe, reports and observational studies highlight risks such as euglycemic ketoacidosis during prolonged fasting and surgery. Rigorous monitoring and individualized evaluation of hospitalized patients are essential. Future studies should focus on the safety and efficacy of iSGLT2 in this group, as well as strategies to mitigate the associated risks.
dc.format.extent52 pp
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.48713/10336_43039
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/43039
dc.language.isospa
dc.publisherUniversidad del Rosario
dc.publisherUniversidad CES. Facultad de Medicina
dc.publisher.departmentEscuela de Medicina y Ciencias de la Salud
dc.publisher.programEspecialización en Epidemiología
dc.rightsAttribution-NonCommercial-ShareAlike 4.0 International*
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)
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dc.source.instnameinstname:Universidad del Rosario
dc.source.reponamereponame:Repositorio Institucional EdocUR
dc.subjectAdultos
dc.subjectHospitalización
dc.subjectiSGLT2
dc.subjectEventos adversos
dc.subject.keywordAdult
dc.subject.keywordHospitalization
dc.subject.keywordSGLT2 inhibitors
dc.subject.keywordAdverse events
dc.titleEventos adversos asociados al inicio de iSGLT2 en pacientes adultos hospitalizados: una revisión de alcance
dc.title.TranslatedTitleAdverse events associated with the initiation of SGLT2 Inhibitors in hospitalized adult patients: a scoping review
dc.typebachelorThesis
dc.type.documentTrabajo de grado
dc.type.hasVersioninfo:eu-repo/semantics/acceptedVersion
dc.type.spaTrabajo de grado
local.department.reportEscuela de Medicina y Ciencias de la Salud
local.regionesBogotá
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Especialización en Epidemiología