Recomendaciones de un grupo de especialistas sobre el uso del monitoreo continuo de glucosa con el sistema FreeStyle Libre en Costa Rica
DOI:
https://doi.org/10.51481/amc.v67i4.1481Palabras clave:
Monitoreo Continuo de Glucosa, Diabetes Mellitus, Freestyle Libre, Costa RicaResumen
Introducción: El monitoreo continuo de glucosa ha transformado la atención de la diabetes a nivel mundial; sin embargo, en Costa Rica no existen guías nacionales que orienten su uso clínico. Este consenso tuvo como objetivo desarrollar recomendaciones basadas en la evidencia y específicas para cada contexto, para la implementación del monitoreo continuo de glucosa en el sistema de salud costarricense. Métodos: Se realizó una revisión bibliográfica estructurada centrada en FreeStyle Libre 14 días y FreeStyle Libre 2, que incluyó publicaciones entre 2015 y el 16 de noviembre de 2024. Con base en esa evidencia se desarrollaron diez escenarios clínicos adaptados a la práctica local. Un panel de seis endocrinólogos de los sectores público y privado se reunió en San José el 1 de febrero de 2025 y utilizó un método Delphi modificado para elaborar y aprobar recomendaciones con un umbral de acuerdo ≥80%. Resultados: El panel emitió 20 recomendaciones. El monitoreo continuo de glucosa se aprobó como estándar de atención en la diabetes tipo 1 y durante el embarazo con diabetes tipo 1. Se apoyó el uso selectivo en la diabetes tipo 2, especialmente en pacientes tratados con insulina, aquellos con riesgo de hipoglucemia y como herramienta educativa a corto plazo, considerando las particularidades del sistema de salud costarricense. Se recomendó su uso durante la hospitalización en pacientes estables capaces de autocontrolarse. Se desaconsejó el uso rutinario del monitoreo continuo de glucosa en pacientes críticos, personas sin apoyo de cuidadores o en diálisis. Todos los usos deben ir acompañados de educación y supervisión clínica. Conclusiones: Estas recomendaciones sobre el monitoreo continuo de glucosa en Costa Rica proporcionan una guía clara y práctica para la implementación local y destacan las prioridades para futuras investigaciones, educación y políticas de salud.
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