Current approaches to controlling type 2 diabetes


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Abstract

At present, about 250 million subjects suffer from type 2 diabetes (T2D) in the world. Scientists assume that this figure will amount to 380 million subjects by 2025. Macrovascular complications hold the lead in the structure of mortality in patients with T2D. Chronic hyperglycemia is known to be a cause of the development and progression of T2D. As for effective diabetes control, there is strong evidence suggesting that better glycemic control can considerably reduce a risk for both micro- and macroangiopathy. To what values glycosylated hemoglobin (HbA1c) should be reduced to prevent complications due to T2D, currently remains an urgent problem. Based on the largest studies dealing with this problem, recommendations have been formulated for different groups of patients: to achieve HbA1c levels of < 7% for all patients; < 6% for those at relatively low risk for hypoglycemia, and in the range from 7.5 to 8% for those at its high risk.

References

  1. International Diabetes Federation. Diabetes and cardiovascular disease: Time to act. Brussels: International Diabetes Federation; 2001.
  2. King H., Aubert R. E., Herman W. H. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabet. Care 1998; 21 (9): 1414-1431.
  3. Niskanen L., Turpeinen A., Penttila I., Uusitupa M. I. Hyperglycemia and compositional lipoprotein abnormalities as predictors of cardiovascular mortality in type 2 diabetes: a 15-year follow-up from the time of diagnosis. Diabet. Care 1998; 21 (11): 1861-1869.
  4. Manson J. E., Colditz G. A., Stampfer M. J. et al. A prospective study of maturity-onset diabetes mellitus and risk of coronary heart disease and stroke in women. Arch. Intern. Med. 1991; 151: 1141-1147.
  5. Neaton J. D., Wentworth D. N., Cutler J. et al. Risk factors for death from different types of stroke. Multiple Risk Factor Intervention Trial Research Group. Ann. Epidemiol. 1993; 3: 493-499.
  6. Stratton J. M., Adler A. I., Neil A. W. et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective, observational study. Br. Med. J. 2000; 321: 405-412.
  7. Дедов И. И., Шестакова М. В. Сахарный диабет. М.: Универсум Паблишинг; 2003: 231-242; 244-256; 263-267, 282-289.
  8. Дедов И. И., Шестакова М. В. Диабетическая нефропатия. М.: Универсум Паблишинг; 2000: 239.
  9. Lustman P. J., Clouse R. E. Depression in diabetic patients: the relationship between mood and glycemic control. J. Diabet. Complicat. 2005; 19 (2): 113-122.
  10. Avignon A., Radauceanu A., Monnier L. Nonfasting plasma glucose is a better marker of diabetic control than fasting plasma glucose in type 2 diabetes. Diabet. Care 1997; 20: 1822-1826.
  11. Bonora E., Calcaterra F., Lombardi S. et al. Plasma glucose levels throughout the day and HbA1c interrelationships in type 2 diabetes: implications for treatment and monitoring of metabolic control. Diabet. Care. 2001; 24: 2023-2029.
  12. Rohlfing C. L., Wiedmeyer H. S., Little R. et al. Defining the relationship between plasma glucose and HbA1c. Diabet. Care. 2002; 25: 275-278.
  13. American Diabetes Association: Standards of medical care in diabetes. Diabet. Care 2006; 29 (suppl. 1): S4-S42.
  14. Sacks D. B., Bruns D. E., Goldstein D. E. et al. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (Position Statement). Diabet. Care 2002; 25: 750-786.
  15. Gorus Fm., Mathieu C., Gerlo E. How should HbAlc measurements be reported? Diabetologia 2006; 49: 7-10.
  16. Selvin E., Marinopoulos S., Berkenblit G. et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann. Intern. Med. 2004; 141: 421-431.
  17. Aldasouqi S. A., Gossain V. V. Hemoglobin A1c: Past, present and future. Ann. Saudi Med. 2008; 28 (6): 411-419.
  18. Cooppan R. Type 2 Diabetes: The Pathophysiologic Basis of Treatment Design, http://cme.medscape.com/viewprogram/ 17327_learning
  19. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352 (9131): 837-853.
  20. Parris E. S., Lawrence D. B., Mohn L. A., Long L. B. Diabet. Care 2005; 28 (3): 595-599.
  21. Karalliedde J., Gnudi L. ACCORD and ADVANCE: a tale of two studies on the Merits control in type 2 diabetic patients. Nephrol. Dial. Transplant. 2008; 23 (6): 1796-1798.
  22. Soo Yeon S., Nesto R. W. Implications of intensive glycemic control on cardiovascular disease: early reports from the ACCORD and ADVANCE Trials. Rev.Cardiovasc. Med. 2008, 9 (l): 1-4.
  23. Radermecker R. P., Philips J. C., Jandrain B. et al. Blood glucose control and cardiovascular disease in patiens with type 2 diabetes. Results of ACCORD, ADVANCE and VA-Diabetes trials. Rev. Med. Liege 2008; 63 (7-8): 511-518.
  24. Hauner H. HbAlc of 6.5%. A rigid goal in diabetes therapy? (interview by Dr. Dirk Einecke). MMW Fortschr. Med. 2008; 150 (26-27): 16.
  25. Füchtenbusch M., Hummel M. Intensive blood sugar treatment in type 2 diabetics: no evidence for increased mortality in the ADVANCE study compared with ACCORD study. MMW Fortschr. Med. 2008; 150 (17): 42-44.
  26. Patel A. ADVANCE Collaborative Group, MacMahon S., et al. Effects of a fixed combination of perindopril and indapamide on macrovascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomized controlled trial. Lancet 2007; 370: 829-840.
  27. Monami M. Are sulfonylureas all the same? A cohort study on cardiovascular and cancer-related mortality. Diabet. Metab. Res. Rev. 2007; 23: 479-484.
  28. Selvin E., Marinopoulos S., Berkenblit G. et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann. Intern. Med. 2004; 141: 421-431.
  29. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352 (9141): 837-853.
  30. Dluhy R. G., McMahon G. T. Intensive glycemic control in the ACCORD and ADVANCE trials. N. Engl. Med. 2008; 358 (24): 2630-2633.
  31. Duckworth W., Abraira C., Moritz T. et al. Glucose control and vascular complications in veterans with type 2 diabetes. N. Engl. J. Med. 2009; 360: 129-139.
  32. Stettler C., Allemann S., Jüni P. et al. Glycemic control and macrovascular disease in types 1 and 2 diabetes mellitus: meta-analysis of randomized trials. Am. Heart. J. 2006; 52: 27-38.
  33. Nathan D. M., Cleary P. A., Backlund J. Y. et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N. Engl. J. Med. 2005; 353: 2643-2653.
  34. Gaede P., Lund-Andersen H., Parving H.-H., Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N. Eng. Med. 2008; 358: 580-591.
  35. Skyler J. S., Bergenstal R., Bonow R. O. et al. Expert consensus document. Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes Trials. J. Am. Coll. Cardiol. 2009; 53: 298-304.
  36. Reichard P., Bengt-Nilsson B.-Y., Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N. Engl. J. Med. 1993; 329: 304-309.
  37. The Diabetes Control and Complications Trial Research Group The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N. Engl. J. Med. 1993; 329: 977-986.
  38. Ohkubo Y., Kishikawa H., Araki E. et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabet. Res. Clin. Pract. 1995; 28: 103-117.
  39. Buse J. B., Ginsberg H. N., Bakris G. L. et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation 2007; 115: 114-126.
  40. The ADVANCE Collaborative Group. N. Engl. J. Med. 2008; 358; 2560-2572.
  41. ADVANCE Management Committee. Study Rational and Design of ADVANCE: Action in diabetes and vascular disease-preterax and diamicron MR controlled evaluation. Diabetologia 2001; 44: 1118-1120.

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