<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2393-6797</journal-id>
<journal-title><![CDATA[Revista Uruguaya de Medicina Interna ]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Urug. Med. Int.]]></abbrev-journal-title>
<issn>2393-6797</issn>
<publisher>
<publisher-name><![CDATA[Sociedad de Medicina Interna del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2393-67972021000300004</article-id>
<article-id pub-id-type="doi">10.26445/06.03.1</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Antidiabéticos en Insuficiencia Cardíaca]]></article-title>
<article-title xml:lang="en"><![CDATA[Antidiabetics in Heart Failure]]></article-title>
<article-title xml:lang="pt"><![CDATA[Antidiabéticos na Insuficiência Cardíaca]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García Rojas]]></surname>
<given-names><![CDATA[Zulay Andrea]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Cristancho Sierra]]></surname>
<given-names><![CDATA[Diana Marcela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Papadópulos]]></surname>
<given-names><![CDATA[Amalia Verónica Pérez]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ormaechea Gorricho]]></surname>
<given-names><![CDATA[Gabriela]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Facultad de Medicina Unidad Multidisciplinaria de Insuficiencia Cardíaca]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2021</year>
</pub-date>
<volume>6</volume>
<numero>3</numero>
<fpage>4</fpage>
<lpage>21</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S2393-67972021000300004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S2393-67972021000300004&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S2393-67972021000300004&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen:  Introducción: La insuficiencia cardíaca se reconoce como una enfermedad sistémica, por lo que se debe hacer un abordaje holístico y no enfocado exclusivamente a la falla cardíaca. La insuficiencia cardíaca se asocia con múltiples comorbilidades, siendo la diabetes mellitus una de las más frecuentes, estas comparten procesos fisiopatológicos con un comportamiento bidireccional, donde la mala evolución de una puede afectar a la otra. Por tanto, al considerar el tratamiento farmacológico de una de ellas, hay que tener en cuenta que el mismo no sea deletéreo para la otra. En los últimos años se requiere que cualquier tratamiento antidiabético tenga un efecto beneficioso o neutro a nivel cardiovascular. Este hecho es el constante desafío clínico al que el médico se enfrenta en estos pacientes. El objetivo de esta revisión es hacer una puesta a punto de la mejor evidencia disponible en el uso de los antidiabéticos en pacientes con insuficiencia cardíaca.  Métodos:  Se realizó una revisión sistemática de los principales estudios observacionales, ensayos clínicos, revisiones y metaanálisis publicados del uso de antidiabéticos y efecto cardiovascular, hasta diciembre del 2020, utilizando la base de datos de Pubmed y ScienceDirect.  Conclusiones:  De la revisión realizada se puede concluir que el fármaco de primera línea en pacientes con diabetes e insuficiencia cardíaca es la metformina, compartiendo este primer eslabón con los iSGLT2 (Empagliflozina, Canagliflozina y Dapagliflozina), según la última evidencia disponible, los que han demostrado ser eficaces en la reducción de las hospitalizaciones por insuficiencia cardíaca entre los pacientes con o sin diabetes y muerte cardiovascular, recientes estudios extienden además beneficio a los pacientes que también asocian enfermedad renal crónica.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract:  Introduction:  Heart failure is recognized as a systemic disease, thus a holistic approach that is not exclusively focused on heart failure should be used. Heart failure is associated with multiple comorbidities, being diabetes mellitus one of the most frequent. These share pathophysiological processes with a bidirectional behavior, where the poor evolution of one can affect the other. Therefore, when considering the pharmacological treatment of one of them, it must be taken into account that it should not be detrimental to the other. In recent years, any antidiabetic treatment is required to have either a beneficial or a neutral effect at the cardiovascular level. This fact is the constant clinical challenge that physicians have to deal with when treating these patients. The objective of this review is to refine the best available evidence on the use of antidiabetic agents in patients with heart failure.  Methods:  A systematic review of the main observational studies, clinical trials, reviews and meta-analysis published on the use of antidiabetics agents and cardiovascular effect was carried out until December 2020, using Pubmed and ScienceDirect databases.  Conclusions:  From the review carried out, it can be concluded that the first-line drug for patients with diabetes and heart failure is metformin. This first link is shared with iSGLT2 (Empagliflozin, Canagliflozin and Dapagliflozin), according to the latest available evidence, which have been proven to be effective in reducing hospitalizations for heart failure among patients with or without diabetes and cardiovascular death. Recent studies also extend benefits to patients who are also associated with chronic kidney disease.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo:  Introdução: A insuficiência cardíaca é reconhecida como uma doença sistêmica, portanto, uma abordagem holística deve ser feita e não focada exclusivamente na insuficiência cardíaca. A insuficiência cardíaca está associada a múltiplas comorbidades, o diabetes mellitus uma das mais frequentes, pois compartilham processos fisiopatológicos com comportamento bidirecional, onde a má evolução de um pode afetar o outro. Portanto, ao se considerar o tratamento farmacológico de um deles, deve-se levar em consideração que não é prejudicial ao outro. Nos últimos anos, qualquer tratamento antidiabético é necessário para ter um efeito benéfico ou neutro no nível cardiovascular. Esse fato é o constante desafio clínico que o médico enfrenta nesses pacientes. O objetivo desta revisão é fazer uma pesquisa das melhores evidências disponíveis sobre o uso de anti-diabeticos em pacientes com insuficiência cardíaca.  Métodos:  Foi realizada uma revisão sistemática dos principais estudos observacionais, ensaios clínicos, revisões e metanálises sobre o uso de antidiabéticos e efeito cardiovascular, até dezembro de 2020, nas bases de dados Pubmed e ScienceDirect.  Conclusões:  A partir da revisão realizada, pode-se concluir que o medicamento de primeira linha em pacientes com diabetes e insuficiência cardíaca é a metformina, compartilhando esta primeira linha com o iSGLT2 (Empagliflozin, Canagliflozin e Dapagliflozin), de acordo com as últimas evidências disponíveis, para aqueles que se mostraram eficazes na redução de hospitalizações por insuficiência cardíaca entre pacientes com ou sem diabetes e morte cardiovascular, estudos recentes também estendem o benefício a pacientes que também associam doença renal crônica.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[antidiabéticos]]></kwd>
<kwd lng="es"><![CDATA[diabetes]]></kwd>
<kwd lng="es"><![CDATA[insuficiencia cardiaca]]></kwd>
<kwd lng="es"><![CDATA[iSGLT2]]></kwd>
<kwd lng="es"><![CDATA[cardiovascular]]></kwd>
<kwd lng="en"><![CDATA[antidiabetic drugs]]></kwd>
<kwd lng="en"><![CDATA[diabetes]]></kwd>
<kwd lng="en"><![CDATA[heart failure]]></kwd>
<kwd lng="en"><![CDATA[iSGLT2]]></kwd>
<kwd lng="en"><![CDATA[cardiovascular]]></kwd>
<kwd lng="pt"><![CDATA[drogas antidiabéticas]]></kwd>
<kwd lng="pt"><![CDATA[diabetes]]></kwd>
<kwd lng="pt"><![CDATA[insuficiência cardíaca]]></kwd>
<kwd lng="pt"><![CDATA[iSGLT2]]></kwd>
<kwd lng="pt"><![CDATA[cardiovascular]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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