Téma: 

Is intensive reducing of glycemia in type ii diabetes mellitus safe? the answer can be found in results of the advance study

Boris Krahulec

The ADVANCE clinical study finalized at the end of 2007 observed morbidity and mortality data in patients with type 2 diabetes mellitus. The survey was to compare one group of patients managed with intensive treatment with another one treated in the standard way. The therapeutic goals of the study were initially to achieve a specific therapeutic effect - HbA1c level under 6.5 % and, additionally, to decrease the fasting glycemia level below 6 mmol/l. The first choice drug in the treatment of diabetes was gliclazide MR (Diaprel MR) because of its ability to adjust secretion abnormalities of insulin and to protect beta-cells and vascular tissue against oxidative stress as well as to sustain consistent glycemia control without significant risk of hypoglycemia. Results of the ADVANCE trial showed that intensified anti-hypertensive treatment with a drug combination composed of perindopril + indapamid (Noliprel A, Noliprel forte A) reduces relative risk of macro and microvascular events by 9 % and of cardiovascular death by 18 % even independently of blood pressure reduction. Gradual, not overly aggressive reduction of HbA1c to the average level of 6.5 % brings about a 10 % relative reduction in combined macro- and micro-vascular events and a 21 % relative reduction in nephropathy. The rare occurrence of serious cases of hypoglycemia and proven safety of intensified therapeutic treatment with gliclazide MR (Diaprel MR) were other important findings of the trial. Concerns for the occurrence of lethal cardiovascular events raised by findings in the ACCORD clinical study were not supported. There are no doubts the prevention of main secondary complications of type 2 diabetes mellitus demands a multi-factorial approach in which consistent glycemia control plays a very important role. However, efforts to achieve a too rapid and aggressive improvement in glycemic compensation in diabetic patients over 60 with existing cardiovascular risk are not appropriate. Gliclazide MR (Diaprel MR) was shown to be a safe and effective drug that is well established in the strategy of intensification of glycemic compensation in order to maintain reduction of chronic vascular complications of diabetes and therefore it becomes an important medication for patients with type 2 diabetes mellitus.

Ročník 2008  Témy časopisu Internal medicine 10 / 2008

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