Téma: 

New therapeutic approaches in prevention of diabetic vascular complications - what we expect from the results of advance study

Boris Krahulec

It is well known that improvement of diabetes management leads to decreasing micro and macrovascular complications in patients with diabetes mellitus. However, it is necessary to get more results from larger clinical studies to confirm this hypothesis. One of these is the ADVANCE clinical study just being finished and its final results are expected in the first half of this year. The aim of the study was to focus on the two principles of the treatment of diabetes mellitus - more intensive treatment of both arterial hypertension and hyperglycemia. The cornerstone of antidiabetic treatment in this study was gliclazide MR additionally supported by oral antidiabetics or possibly insulin. Gliclazide MR (in Slovakia known as Diaprel MR) not only decreases glycemia but is also free radical scavenger, thereby preventing vascular complications. Gliclazide reduces progression of atherosclerosis. In parallel with the ADVANCE study, the ACCORD study is focusing on influencing cardiovascular complications occurring in patients with diabetes mellitus. The part of the study intended to show the positive effect of intensive glycemic control has been stopped recently. The reason for the halt was the finding of increasing mortality in the group of patients with diabetes that were treated more intensively. That finding created concern that intensive decreases in glycemic values below contemporary clinically recommended values can be dangerous for high risk populations of patients with type 2 diabetes mellitus. However, preliminary results of the ADVANCE study did not confirmed increased mortality of intensively treated patients. Currently, the overall professional public is impatiently expecting results of the glycaemic arm in the ADVANCE study as it may influence treatment strategy in prevention of vascular complications of diabetes.

Ročník 2008  Témy časopisu Internal medicine 3 / 2008

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