Impact of data from recent clinical trials on strategies for treating patients with type 2 diabetes mellitus

Abstract

Type 2 diabetes is associated with increased risk for the development of cardiovascular disease (CVD) secondary to hyperglycemia's toxicity to blood vessels. The escalating incidence of CVD among patients with type 2 diabetes has prompted research into how lowering glycated hemoglobin (HbA1c) may improve CVD-related morbidity and mortality. Data from recent studies have shown that some patients with type 2 diabetes actually have increased mortality after achieving the lowest possible HbA1c using intensive antidiabetes treatment. Multiple factors, such as baseline HbA1c, duration of diabetes, pancreatic β-cell decline, presence of overweight/ obesity, and the pharmacologic durability of antidiabetes medications influence diabetes treatment plans and therapeutic results. Hypertension and dyslipidemia are common comorbidities in patients with type 2 diabetes, which impact the risk of CVD independently of glycemic control. Consideration of all of these risk factors provides the best option for reducing morbidity and mortality in patients with type 2 diabetes. Based on the results of recent trials, the appropriate use of current antidiabetes therapies can optimize glycemic control, but use of intensive glucoselowering therapy will need to be tailored to individual patient needs and risks. © 2010 Palumbo and Wert, publisher and licensee Dove Medical Press Ltd.