Ivan Tkáč
Type 2 diabetes is associated with almost threefold occurrence of cardiovascular diseases as well as with microvascular complications. Multifactor interventions are recommended in these patients. Intervention studies have been focused mostly on particular risk factors of vascular complications as e.g. main marker of glycaemic compensation of the level of glycated hemoglobin (HbA1c), higher levels of blood pressure and higher levels of LDL cholesterol. The most important intervention study UKPDS showed the benefit of better glycaemic compensation as well as more aggressive therapy in prevention of microvascular complications of diabetes and cardiovascular diseases. Pilot study Steno-2 aimed at multifactor interventions (glycaemic compensation, treatment of dyslipidaemia and hypertension) showed at a small number of diabetics with microalbuminuria the benefit of the three interventions on the development of macrovascular and also on microvascular complications of type II diabetes. Two studies are being finished with more than 10 000 randomized diabetics. The study ACCORD is monitoring the effect of better glycaemic compensation and better control of hypertension than recommended and possible benefit of addition of fibrate therapy to the present therapy with statin in treatment of dyslipidaemia. Results of the study will be published in 2010. The study ADVANCE is monitoring the effect of better hypertension cotrol on basis of antihypertensive therapy involving fixed double combination of perindopril/indapamid, as well as the effect of better glycaemic compensation using therapeutic regimes involving sulfonylureu gliklazid MR. The results of its antihypertensive branch will be published in 2007 and antidiabetic branch in 2008. The results of the two studies ADVANCE and ACCORD can have implications for clinical practice in relation with target values of blood pressure and HbA1c as well as in relation with drugs of choice used to get these therapeutic goals.